Adverse Health Outcomes Associated with Surgical Management of the Small Renal Mass

Shuch, Brian; Hanley, Janet; Lai, Julie; Vourganti, Srinivas; Setodji, Claude Messan; Dick, Andrew W.; Chow, Wong‐Ho; Saigal, Chris

doi:10.1016/j.juro.2013.08.074

Cited by 46 publications

(25 citation statements)

References 28 publications

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“…A longer latency is present among those undergoing PN, thus potentially biasing the results towards a benefit for PN in patients without adequate follow-up. However, the finding of differences in the rate of renal events between RN and PN has been reported recently within a similar time frame in another population-based study, enhancing the validity of our present finding [33]. There are probably two patterns of progression to RRT in the post-surgical setting.…”

Section: Discussionsupporting

confidence: 88%

Partial nephrectomy for the treatment of renal cell carcinoma (RCC) and the risk of end‐stage renal disease (ESRD)

et al. 2015

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ObjectiveTo assess whether radical nephrectomy (RN) compared with partial nephrectomy (PN) for the treatment of renal cell carcinoma (RCC) is associated with greater risk of end-stage renal disease (ESRD). Patients and MethodsWe performed a population-based, retrospective cohort study using linked administrative databases in the province of Ontario, Canada. We included individuals with pathologically confirmed RCC diagnosed between 1995 and 2010. Cox proportional hazards, propensity score, and competing risks models were used to assess the impact of treatment choice. The primary outcome was ESRD. Secondary outcomes included overall mortality, myocardial infarction, and new-onset chronic kidney disease (CKD). A modern cohort of patients (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010) was analysed separately. ResultsWe included 11 937 patients, of whom 2107 (18%) underwent PN. The median follow-up was 57 months. In the full cohort, type of surgery was not associated with the rate of ESRD, whereas PN was associated with a decreased likelihood of ESRD compared with RN in the modern cohort using a multivariable proportional hazards model [hazard ratio (HR) 0.44, 95% confidence interval (CI) 0.25-0.75) or propensity score modelling (HR 0.48,. PN was also associated with a lower risk of new-onset CKD (HR 0.48, 95% CI 0.41-0.57). ConclusionsAlthough it is well-known that RN is associated with more CKD than PN, we provide the first direct evidence that PN is associated with less ESRD requiring renal replacement therapy than RN in a modern cohort of patients with RCC.

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Section: Discussionsupporting

confidence: 88%

Partial nephrectomy for the treatment of renal cell carcinoma (RCC) and the risk of end‐stage renal disease (ESRD)

et al. 2015

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“…Unfortunately, they did not directly compare the two treatments to verify a difference in the risk of cardiovascular events associated with one type of treatment for RCC [34].…”

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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“…Akin to HLRCC, management of kidney tumors in SDH individuals involves early detection and wide surgical excision [ 80 ]. There has also been a recent report of VEGF-targeted therapy for a female patient with metastatic disease, where treatment with sunitinib was met with a near complete response [ 81 ].…”

Section: Hlrcc/sdhmentioning

confidence: 99%

Hereditary Kidney Cancer Syndromes

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Shuch

2015

Kidney Cancer

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Adverse Health Outcomes Associated with Surgical Management of the Small Renal Mass

Cited by 46 publications

References 28 publications

Partial nephrectomy for the treatment of renal cell carcinoma (RCC) and the risk of end‐stage renal disease (ESRD)

Partial nephrectomy for the treatment of renal cell carcinoma (RCC) and the risk of end‐stage renal disease (ESRD)

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

Hereditary Kidney Cancer Syndromes

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