Partial versus radical nephrectomy in clinical T2 renal masses

Abstract

Objective To report perioperative, renal functional and oncologic outcomes for patients undergoing partial or radical nephrectomy for cT2 renal masses. Methods Retrospective review of patients who underwent partial (n = 72) or radical nephrectomy (n = 379) for cT2 renal masses from 2000 to 2016. After propensity adjustment using inverse probability weighting, the following were compared by surgery (partial or radical nephrectomy): complications, renal function measured by estimated glomerular filtration rate as continuous and as <60 mL/min/1.73 m2 at 1 and 3 years postoperatively and overall, metastases‐free survival and cancer‐specific survival in patients with renal cell carcinoma. Results After propensity adjustment, clinical and radiographic features were well‐balanced between groups. Overall and severe complications were more common for partial compared with radical nephrectomy, although not statistically significant (19 vs 13%, P = 0.14 and 4 vs 2%, P = 0.3, respectively). Estimated glomerular filtration rate change at 1 and 3 years was more pronounced in radical compared with partial nephrectomy (median −16 vs −5 and −14 vs −2, respectively, P < 0.001). A greater proportion of radical nephrectomy patients had an estimated glomerular filtration rate <60 at 1 and 3 years (55 vs 17% and 48 vs 17%, respectively, P < 0.01). In renal cell carcinoma patients, overall, metastases‐free and cancer‐specific survival were not significantly different between groups (median survivor follow up 7.1 years, interquartile range 3.6–11.4). Conclusions Partial nephrectomy appears to be a relatively safe and a potentially effective treatment for cT2 renal masses, conferring better renal functional preservation compared with radical nephrectomy. These data support continued use of partial nephrectomy for renal masses >7 cm in appropriately selected patients.

Partial Nephrectomy for T1b/T2 Renal Mass

“…There were no differences in eGFR between the preoperative and postoperative periods, according to our findings. This is consistent with previous findings that the decrease in eGFR after PN is significantly lower than that after RN ( 10 , 11 ). A meta-analysis included 15 retrospective studies involving 5056 patients who had nephrectomy (PN: 1975, RN: 3081).…”

“…The result of one study comparing survival after PN versus RN among 11,256 cases of RCCs of 4–7 cm between 1998 and 2007 found no difference in survival in patients after adjusting for tumor size and age ( 6 ). A recent retrospective review of patients who underwent PN (n = 72) or RN (n = 379) for cT2 renal masses from 2000 to 2016 also found that metastases-free and cancer-specific survival were not significantly different between groups in patients with RCC ( 10 ).…”

“…Our experience with open PN has yielded promising results for treating large renal masses, with only 2% of grade 3 complications necessitating further management reported during postoperative evaluation and patient follow-up. In terms of complications, some studies did show that PN was associated with a higher complications rate compared to RN ( 4 , 10 , 11 ). In a study by Long et al, 16 complications with a median (range) follow-up of 13.1 months, including 8.2% blood transfusions and 12.2% urinary fistulae, were reported from 46 cases of large renal tumor managed by PN ( 5 ).…”

Predicting Clear Cell Renal Cell Carcinoma Survival Using Kurtosis of Cytoplasm in the Hematoxylin Channel from Histology Slides

“…Currently, partial nephrectomy is the mainstream surgical method for small and medium-sized localized renal tumors [ 14 ]. However, renal tumor recurrence occurred in some patients after partial nephrectomy [ 15 , 16 ].…”

Recent Advances in the Management of Localized and Locally Advanced Renal Cell Carcinoma: A Narrative Review

“…These data were based on primary open-approach PN. 2 , 11–14 Contemporary analyses with robot-assisted PN (RAPN), however, suggest a decreased morbidity profile while maintaining oncological equipoise and functional benefit for PN. Bertolo et al complied a series of 298 patients with cT2a tumors who underwent PN with a median follow-up of 12 months.…”