Clinical outcomes following laparoscopic management of pT3 renal masses: A large, multi-institutional cohort

Abstract

Introduction: We described the clinical and oncological outcomes of patients treated by laparoscopic surgery for non-metastatic pT3 renal cell carcinoma (RCC). Methods: We queried a multi-institutional database for patients diagnosed with non-metastatic pathological T3 RCC from 13 Canadian centres treated laparoscopically (radical or partial nephrectomy) between 2008 and 2014. Clinical and pathological outcomes were evaluated. Progression was defined as the development of recurrence or metastatic disease. Log-rank testing and Kaplan-Meier statistical methods assessed for differences and estimated progression-free survival (PFS). Results: In total, 176 patients were identified with a median age of 64 years. The median tumour size was 7.0 cm. Pre-clinical stage was cT1 to cT4 in 39%, 28%, 30% and 3%, respectively. The median blood loss was 150 mL (range: 0-6000) and the median operative time was 124 minutes (range: 60-360). Most lesions were clear cell RCC (80%). After a median follow-up of 17.6 months (range: 0.2-75.0), disease progression occurred in 26% (46/176) of patients, consisting of local recurrence in 7% (3/46), and metastatic disease in 93% (43/46). The 3-year PFS was 67%, with a median PFS of 49 months. Of those who progressed, the median time to progression was 10.3 months. Conclusions: This study is the largest cohort of pT3 RCC patients treated laparoscopically in the literature and suggests that for properly selected patients, laparoscopic management of locally advanced renal masses yields acceptable short-term oncological outcomes.

Partial Nephrectomy Versus Radical Nephrectomy for Endophytic Renal Tumors: Comparison of Operative, Functional, and Oncological Outcomes by Propensity Score Matching Analysis

“…Multivariate analysis confirmed that RN and pT3 stages were the predictors of overall mortality. The present results showed that non-metastatic pT3 RCC after laparoscopic management incurred metastatic progression of 26% and the three-year mortality rate was 33%(46). A study by Leibovich et al(47) has shown that the risk ratio for death is 1.87 times higher in patients with peripheral perinephric or renal sinus fat invasion compared with those without fat invasion (p <0.001).…”

Outcomes and prognosticators of stage 4 renal cell carcinoma with pathological T4 primary lesion using a large Canadian multi-institutional database

“…The Canadian Kidney Cancer information system (CKCis) is a collaborative multi-institutional database from 13 centers in 6 provinces and has been described previously. [18][19][20] This dataset was initiated in 2011 and includes data entered retrospectively and prospectively for a sample of patients with renal tumors treated as of 1998. Demographic, clinical, pathological, and oncological variables are collected and the dataset is updated regularly.…”

Laparoscopic Radical Nephrectomy in Patients with Locally Advanced Renal Cell Carcinoma: Initial Experience

“…43 patients had distant metastasis and 3 patients had local recurrence. 6 patients died due to kidney cancer [15]. In another study involving 94 patients who underwent LRN for locally advanced disease, the follow-up period was 24.8 months.…”

“…Nayak, et al shared the results of 176 T3 RCC patients who underwent laparoscopic surgery. They reported the mean tumor size of 7 cm, the mean operation time of 124 min, and the mean estimated blood loss of 150 cc [15]. The mean operative time of the patients who underwent LRN for 94 locally advanced RCC was 150 minutes, the mean estimated blood loss was 100 cc, the conversion from laparoscopic to open surgery was 6.4%, and the hospital stay was 5 days [16].…”