Partial Versus Radical Nephrectomy in Patients With Adverse Clinical or Pathologic Characteristics

Jeldres, Claudio; Patard, Jean Jacques; Capitanio, Umberto; Perrotte, Paul; Suardi, Nazareno; Crépel, Maxime; Ficarra, Vincenzo; Cindolo, Luca; Taille, Alexandre de la; Tostain, Jacques; Pfister, Christian; Albouy, Baptiste; Colombel, Marc; Méjean, A.; Lang, Hervé; Jacqmin, Didier; Bernhard, Jean-Christophe; Ferrière, J.; Bensalah, Karim; Karakiewicz, Pierre I.

doi:10.1016/j.urology.2008.08.492

Cited by 71 publications

(53 citation statements)

References 24 publications

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“…[5][6][7]22,23 Less is known regarding larger masses; however, there is growing evidence for PN both for imperative and elective indications. [14][15][16][17]24 These studies suggest that tumor size should not be an independent contraindication to PN. 11,12,16 Previous studies have not clearly defined if there is a tumor size and complexity plateau at which point PN may not confer renal functional benefit over RN.…”

Section: Commentmentioning

confidence: 80%

“…9 The body of literature on PN for T2RM is growing despite there being no consensus opinion on utility of PN in this setting. [10][11][12][13][14][15][16] Comparative studies of RN and PN for T2RM that specifically examine renal functional outcomes are limited. RENAL nephrometry score includes additional measures of anatomic differences between tumors, in addition to the tumor-parenchyma relationship, which correlates with renal functional outcomes and procedure selection.…”

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confidence: 99%

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Analysis of Renal Functional Outcomes After Radical or Partial Nephrectomy for Renal Masses ≥7 cm Using the RENAL Score

Kopp

Liss

Mehrazin

et al. 2015

Urology

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Section: Commentmentioning

confidence: 80%

mentioning

confidence: 99%

Analysis of Renal Functional Outcomes After Radical or Partial Nephrectomy for Renal Masses ≥7 cm Using the RENAL Score

Kopp

Liss

Mehrazin

et al. 2015

Urology

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“…It has been demonstrated that NSS is equivalent to RN in terms of cancer control [8,[16][17][18][19]. Although conservative surgery may be more challenging, especially for larger and more complex tumors [20], NSS is associated with better functional outcomes when compared to RN [21]. Finally, recent data have suggested a potential benefit in terms of decreasing the risk of subsequent CVe in patients treated with NSS in comparison to RN.…”

Section: Discussionmentioning

confidence: 99%

Nephron-sparing Techniques Independently Decrease the Risk of Cardiovascular Events Relative to Radical Nephrectomy in Patients with a T1a–T1b Renal Mass and Normal Preoperative Renal Function

et al. 2015

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Background: Some reports have suggested that nephron-sparing surgery (NSS) may protect against cardiovascular events (CVe) when compared with radical nephrectomy (RN). However, previous studies did not adjust the results for potential selection bias secondary to baseline cardiovascular risk. Objective: To test the effect of treatment type (NSS vs RN) on the risk of developing CVe after accounting for individual cardiovascular risk. Design, setting, and participants: A multi-institutional collaboration including 1331 patients with a clinical T1a-T1b N0 M0 renal mass and normal renal function before surgery (defined as an estimated glomerular filtration rate 60 ml/min/1.73 m

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“…3,17,18 Four observational studies, using data from 1976-2008, have examined the outcomes of PN for high-risk disease. [11][12][13][14] These studies all showed comparable oncologic outcomes for PN and RN. Only two studies examined OS, finding no difference between PN and RN; however, these studies were underpowered.…”

Section: Discussionmentioning

confidence: 66%

“…Several retrospective studies have investigated the comparative effectiveness of PN vs. RN for high-risk disease, but have failed to detect a survival difference in this setting. [11][12][13][14] Despite its flaws, the only level 1 evidence comparing PN and RN demonstrated a survival advantage for RN, calling into question the long-held belief that PN is necessarily better than RN for the elective management of small renal masses. 15,16 We sought to compare survival outcomes between PN and RN for high-risk disease in a large, nationally representative cohort of American patients in the National Cancer Data Base (NCDB).…”

Section: Introductionmentioning

confidence: 99%

Survival after partial and radical nephrectomy for high-risk disease: A propensity-matched comparison

Maurice

Zhu

Kim

et al. 2016

CUAJ

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Introduction: Increasingly, partial nephrectomy has been applied to high-risk disease without evidence that its survival benefits can be extrapolated to this entity. We aimed to compare overall survival after partial vs. radical nephrectomy in patients with high-risk renal cell carcinoma.Methods: Using the National Cancer Data Base, we identified patients who underwent partial or radical nephrectomy for high-risk disease between 2003 and 2006. High-risk disease was defined as the presence of adverse pathological features within the primary tumour, namely high-grade or unfavourable histology, T3 stage, or both. After matching the partial and radical nephrectomy groups based on propensity scores, 1680, 276, and 76 patients with high-grade or unfavourable histology, T3 stage, or both adverse pathologic features, respectively, were available for analysis. Five-year overall survival was compared after partial vs. radical nephrectomy for each high-risk cohort using the Kaplan-Meier and log rank tests.Results: Partial nephrectomy was associated with a statistically significant improvement in five-year overall survival compared to radical nephrectomy for small tumours (median size 3.0 cm; interquartile range 2.1‒4.5 cm) with high-grade or unfavourable histology (87% vs. 81%; p<0.01) or with pT3a stage (82% vs. 71%; p<0.01). For patients concomitantly harbouring both adverse pathologic features, no difference in survival was detected (p=0.21).Conclusions: Partial nephrectomy is associated with survival benefits in patients with adverse pathologic features, suggesting that renal preservation is not only safe, but also potentially beneficial for high-risk disease. Due to inherent selection bias associated with partial nephrectomy use, prospective validation of these findings is needed.

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Partial Versus Radical Nephrectomy in Patients With Adverse Clinical or Pathologic Characteristics

Cited by 71 publications

References 24 publications

Analysis of Renal Functional Outcomes After Radical or Partial Nephrectomy for Renal Masses ≥7 cm Using the RENAL Score

Analysis of Renal Functional Outcomes After Radical or Partial Nephrectomy for Renal Masses ≥7 cm Using the RENAL Score

Nephron-sparing Techniques Independently Decrease the Risk of Cardiovascular Events Relative to Radical Nephrectomy in Patients with a T1a–T1b Renal Mass and Normal Preoperative Renal Function

Survival after partial and radical nephrectomy for high-risk disease: A propensity-matched comparison

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