The results of radical nephrectomy for renal cell carcinoma

Robson, Charles J.; Churchill, Bernard M.; Anderson, William E.

doi:10.1016/s0022-5347(02)80286-5

Cited by 123 publications

(144 citation statements)

References 0 publications

Supporting

Mentioning

133

Contrasting

Unclassified

Order By: Relevance

“…This surgery involves removal of the entire kidney along with the surrounding tissue within Gerota's Fascia to obtain a wide surgical margin. 17 In its original description, the ipsilateral adrenal gland was routinely excised, though current data does not necessarily support this practice unless there is specific concern for adrenal involvement. [18][19][20][21] RN can be performed through either an open or laparoscopic approach.…”

Section: Radical Nephrectomymentioning

confidence: 99%

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

Yap¹,

Alibhai²,

Tomlinson³

et al. 2013

European Urology Supplements

View full text Add to dashboard Cite

The surgical management of renal masses involves either radical nephrectomy (RN) or partial nephrectomy (PN). PN has been associated with better long-term renal function, and has also been linked to improved cardiac morbidity and overall survival. However, the relationship between treatment choice and definitive outcomes of chronic kidney disease (CKD) are lacking. Our aim was to examine whether PN is associated with a lower risk of end-stage renal disease (ESRD) requiring renal replacement therapy.We performed a population-based, retrospective cohort study with data from linked administrative databases in the province of Ontario, Canada. We included individuals with pathologically confirmed renal cell carcinoma (RCC) diagnosed between 1995 and 2010. Cox proportional hazards (PH) models, propensity score models, and competing risks models were used to assess the impact of treatment choice. PN compared to RN reduces the risk of ESRD requiring renal replacement therapy in a modern cohort of patients (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). PN is associated with a lower risk of new-onset CKD, lower risk of cardiac morbidity, and improved overall survival. We provide further evidence for the benefit of PN compared to RN, particularly related to definitive outcomes of renal failure.iii ACKNOWLEDGEMENTS

show abstract

Section: Radical Nephrectomymentioning

confidence: 99%

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

Yap¹,

Alibhai²,

Tomlinson³

et al. 2013

European Urology Supplements

View full text Add to dashboard Cite

show abstract

“…8 The first formalized staging system for renal tumors was that of Flocks and Kadesky published in 1958 62 (Table 5 65 modified these two staging systems, subdividing localized extrarenal invasion (stage 3) according to the structures involved. In subsequent survival studies the prognostic significance of the Robson staging system has been validated, although significant differences in survival between each of the staging categories was not always observed.…”

Section: Early Staging Classificationsmentioning

confidence: 99%

“…Petkovic 63 classified tumors showing renal capsule and renal vein involvement along with lymph node infiltration as stage 3, although the 5-year survival of this group did not differ from those with metastatic disease. In Robson's classification, 65 which was based on patients who had undergone lymphadenectomy, lymph node infiltration was associated with a 5-year survival of 35% compared with 45% for tumors with renal vein involvement and 11% for patients with distant metastases.…”

Section: Lymph Node Metastasesmentioning

confidence: 99%

Advances and controversies in grading and staging of renal cell carcinoma

2009

View full text Add to dashboard Cite

Despite the considerable progress made in our understanding of the pathogenesis, genetics, and pathology of renal cell carcinoma (RCC), difficulties remain relating to the prediction of clinical outcome for individual cases. Although there is evidence to show that high-grade tumors have a poorer prognosis when compared to those of low grade, debate remains regarding the predictive value of grading, especially for those tumors classified into the intermediate grades. Numerous composite morphologic and nuclear grading systems have been proposed for RCC and although that of the Fuhrman classification have achieved widespread usage, the validity of the grading criteria of this classification has been questioned. In addition, there are few studies that have attempted to validate the Fuhrman system for RCCs beyond that of the clear cell subtype. Recent studies have indicated that grading of papillary RCC should be based on nucleolar prominence alone and that the components of the Fuhrman grading classification do not provide prognostic information for chromophobe RCC. Independent of tumor grade, the prognostic importance of tumor stage for RCC is well recognized. The Union Internationale Contre le Cancer/American Joint Committee for Cancer Staging and End Results Reporting TNM staging system is now in its sixth edition (2002) and recent refinements have focused on defining size cut points that will identify apparently localized tumors that will develop recurrence and/or metastases despite attempted curative surgery. In parallel with these studies it has been shown that infiltration of the renal sinus is an important prognostic factor, being observed in almost all tumors 47 cm in diameter. Questions remain as to the appropriate stratification of regional extension of RCC, as defined in the T3 tumor-staging category. Recent modifications to this category have been suggested combining the level of infiltration of the venous outflow tract with the presence or absence of infiltration of the adrenal gland and/or perirenal fat. Similarly, the utility of classifying lymph node involvement by tumor is debated, although it is well recognized that lymph node infiltration is associated with a poor prognosis. Although the current TNM classification does provide useful prognostic information it would appear that further modifications are justified to enhance the predictive value of staging for RCC.

show abstract

“…T1-T2N0M0 or stage I-II) [1]. Open radical nephrectomy was the standard curative intervention for localised RCC for the past five decades [2]. Furthermore, there were controversies over whether radical nephrectomy should be performed in conjunction with ipsilateral adrenalectomy as originally described by Robson, or if the adrenal should be preserved [3][4][5][6] and whether ipsilateral extended retroperitoneal lymphadenectomy or limited hilar lymphadenectomy should be performed [7,8].…”

Section: Introductionmentioning

confidence: 99%

Systematic Review of Oncological Outcomes Following Surgical Management of Localised Renal Cancer

MacLennan

Imamura

Lapitan³

et al. 2012

European Urology

300

174

View full text Add to dashboard Cite

Context: Renal cell carcinoma (RCC) accounts for 2-3% of adult malignancies. There remain uncertainties over the oncological outcomes for the surgical management of localised RCC. Objective: To systematically review relevant literature comparing oncological outcomes of surgical management of localised RCC (T1-2N0M0). Evidence Acquisition: Relevant databases including MEDLINE, Embase and the Cochrane Library were searched up to October 2010, and an updated scoping search was performed up to January 2012. Randomised or quasi-randomised controlled trials (RCTs), prospective observational studies with controls, retrospective matched-pair studies, and comparative studies from well defined registries/databases were included. The main outcomes were overall survival, cancer-specific survival, recurrence and metastases. The Cochrane risk of bias (RoB) tool was used to assess RCTs and an extended version was used to assess Non Randomised Studies (NRS). The quality of evidence was assessed using GRADE. Evidence Synthesis: 4580 abstracts and 389 full text articles were assessed. 34 studies met the inclusion criteria (6 RCTs and 28 NRSs). Meta-analyses were planned but were deemed inappropriate due to data heterogeneity. There were high risks of bias and low quality evidence across the evidence base. Open radical nephrectomy and open partial nephrectomy showed similar cancer-specific and overall survival, but when both open and laparoscopic approaches are considered together the evidence showed improved survival for partial nephrectomy for tumours ≤4cm.Overall, the evidence suggests either equivalent or better survival with partial nephrectomy. Laparoscopic radical nephrectomy offered equivalent survival to open radical nephrectomy, and all laparoscopic approaches achieved equivalent survival. Open and laparoscopic partial nephrectomy achieved equivalent survival. The issue of ipsilateral adrenalectomy or complete lymph node dissection with radical nephrectomy or partial nephrectomy remains unresolved. Conclusions: The evidence base suggests localised RCC are best managed by nephron sparing surgery where technically feasible. However, the current evidence base has significant limitations due to studies of low methodological quality marked by high risks of bias.

show abstract

The results of radical nephrectomy for renal cell carcinoma

Cited by 123 publications

References 0 publications

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

Advances and controversies in grading and staging of renal cell carcinoma

Systematic Review of Oncological Outcomes Following Surgical Management of Localised Renal Cancer

Contact Info

Product

Resources

About