Oncologic and Functional Outcomes after Partial Nephrectomy Versus Radical Nephrectomy in T1b Renal Cell Carcinoma: A Multicenter, Matched Case-Control Study in Korean Patients

Abstract

PurposeThe study was to compare the oncologic and functional outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) for pathologically proven T1b renal cell carcinoma using pair-matched groups.Materials and MethodsWe reviewed our prospectively maintained database for RN and PN in T1b renal tumors surgically treated between 1999 and 2011 at five institutions in Korea. Of 611 patients treated with PN or RN for a solitary and NX/N0 M0 renal mass (4-7 cm), 577 (PN, 100; RN, 477) patients with pathologically confirmed pT1b remained for analysis. Study subjects were grouped by PN or RN, then matched by age, sex, comorbidities, body mass index, tumor size and depth, histologic type, and preoperative estimated glomerular filtration rate (eGFR) using propensities score. To evaluate oncologic outcomes, overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) rates were analyzed. The functional outcomes were evaluated by postoperative eGFR.ResultsThe median follow-up in the RN group was 48.1 and 42.6 months in the PN group. The estimated 10-year CSS rate (PN 85.7% vs. RN 84.4%, p=0.52) and 5- and estimated 10-year PFS rates (PN: 86.4% and 79.2% vs. RN: 86.0% and 66.1%, p=0.66) did not differ significantly between groups. The estimated 10-year OS rate was significantly higher in the PN group (85.7%) compared to the RN group (73.3%) (p=0.003). PN was less likely to induce new-onset chronic kidney disease (CKD) and end-stage CKD compared with RN.ConclusionOur study suggests that patients treated with PN demonstrate a superior OS rate and postoperative renal function with analogous CSS and PFS rates compared with pair-matched patients treated with RN.

Long-Term Outcome of Nephron-Sparing Surgery Compared to Radical Nephrectomy for Renal Cell Carcinoma ≥4 cm - A Matched-Pair Single Institution Analysis

“…On the other hand, major complications (CD-III to CD-V) were relatively low in both collectives. These findings are in accordance with the prospective study of Van Poppel et al [19] , whereas other studies report equal complication rates for PN and RN procedures [8,11] , showing that complications rates drop with increasing experience of the surgeon [20,21] . Concerning this, we have to mention limiting that we did not include the surgeons experience in this study, which may have affected the complication rate.…”

“…Also, a recent multicenter, matched casecontrol study revealed intriguing insights both in oncologic and functional outcomes after a PN in 100 Korean patients suffering from T1b RCCs. Showing identical survival rates, PN showed a better renal function preservation in their collective [11] . These survival rates are confirmed by recent studies on this topic [12][13][14] .…”

Nephron Sparing Surgery Has Better Oncologic Outcomes Than Extirpative Nephrectomy in T1a but Not in T1b or T2 Stage Renal Cell Carcinoma

“…Yiu et al [23] demonstrated, by using a small cohort that radical nephrectomy increased the risk of new-onset chronic kidney disease but achieved equivalent overall survival in T1 stage patients. This increased risk was supported by various studies [16,24–29]. On the other hand, partial nephrectomy had a lower cardiovascular event risk compared to radical nephrectomy [30].…”

Novel Use of Folate-Targeted Intraoperative Fluorescence, OTL38, in Robot-Assisted Laparoscopic Partial Nephrectomy: Report of the First Three Cases

“…Partial nephrectomy is advantageous over radical nephrectomy for small renal tumors because of nephron preservation, yet it remains noninferior in terms of oncologic outcomes. 1,2 Various modalities are used to increase the negative margin rates during partial nephrectomy. These include intraoperative imaging such as ultrasonography, pathologic assessments such as frozen section, and the use of fluorescent tracers such as indocyanine green to pinpoint the tumor edge.…”

“…1,2 With increasing evidence showing poorer renal function and negative cardiovascular effects after radical nephrectomy, the role of partial nephrectomy as the first-line surgical option is widely accepted. 2,3 Well-performed partial nephrectomies should include two routine criteria: a negative margin without excessive removal of surrounding normal parenchyma and a short warm ischemic time. Various factors have an impact on the outcomes of partial nephrectomy, including surgical approach, surgeons' experience, and the availability of new technologies to improve each critical step during surgery.…”