Conservative Surgery of Renal Cell Carcinoma

Bazeed, Mahmoud A.; Schärfe, T.; Becht, E.; Jurincic, C.; Alken, P.; Thüroff, Joachim W.

doi:10.1016/s0022-5347(17)43918-8

Cited by 26 publications

(4 citation statements)

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“…Elective NSS has a local tumour recurrence risk of 0–7.3%[4,6–10]. In cases of imperative indication, reported local recurrence rates are 0–7%[6,8,11,12]. The most important prognostic factors of survival after NSS are bilateral disease, tumour stage, tumour size and grade [1].…”

Section: Discussionmentioning

confidence: 99%

Impact of resection margin status after nephron‐sparing surgery for renal cell carcinoma

et al. 2006

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OBJECTIVE To evaluate whether the negative‐margin width after nephron‐sparing surgery for renal cell carcinoma (RCC) is associated with tumour recurrence. PATIENTS AND METHODS In all, 121 patients had nephron‐sparing surgery for non‐metastatic RCC for elective (85 cases) and imperative (36 cases) indications. Intraoperative frozen sections were routinely obtained and revealed negative margins in all patients. The tumour size and the shortest distance of normal parenchyma around the tumour were assessed. RESULTS After a mean (range) follow‐up of 49.3 (12‐113) months, six patients had disease progression (three with local recurrence, two of whom also had distant metastases and pure metastatic disease in three). The mean (range) width of the negative margins was 0.56 (0.1–2.3) cm. The width of the resection margin did not correlate with disease progression, while tumour size was a strong predictor of progression (P < 0.02). The mean tumour size was 5.1 cm in patients with progression and 3.1 cm in patients who remained recurrence‐free. CONCLUSIONS Our data suggest that the width of the resection margin, unlike tumour size, does not influence the risk of tumour recurrence.

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Section: Discussionmentioning

confidence: 99%

Impact of resection margin status after nephron‐sparing surgery for renal cell carcinoma

et al. 2006

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“…Based on the observation that at least some patients may have had therapeutic benefit from adrenalectomy when there were undetected adrenal metastases before surgery, adrenalectomy was recommended for all patients undergoing surgery for RCC [13]. In contrast, when leaving the adrenal gland untouched, nephron‐preserving approaches were shown to give a similar prognosis to that of radical surgery [14–17]. Additionally, the relapse‐free survival of patients with RCC undergoing nephrectomy combined with adrenalectomy equalled that after nephrectomy alone [4,12].…”

Section: Introductionmentioning

confidence: 99%

The need for routine adrenalectomy during surgical treatment for renal cell cancer: the Hannover experience

Kuczyk¹,

Münch²,

Machtens³

et al. 2002

BJU International

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Objectives To further clarify the need for routine adrenalectomy during the surgical treatment of renal cell cancer, as in the absence of clinically overt metastatic disease, tumorous lesions within the adrenal gland are found in only 2-10% of patients, with most being over-treated by adrenalectomy. Patients and methods The medical records of 819 patients undergoing adrenalectomy combined with nephrectomy, irrespective of the local extension of the primary tumour or the clinical stage at first diagnosis, were reviewed to determine the reliability of currently available imaging methods in predicting adrenal gland metastases. Several patient and tumour characteristics were correlated with the presence of intra-adrenal metastases, and their possible independent prognostic value was determined by a multivariate logistic regression model. Results There was metastatic spread into the adrenal gland in 27 of 819 (3.3%) patients. In only three of eight patients in whom the adrenal was identified as the only metastatic site were preoperative abdominal computed tomography scans interpreted as falsenegative. On multivariate statistical analysis only the presence of distant metastases, vascular invasion within the primary tumour and multifocal growth of renal cell cancer within the tumour-bearing kidney were identified as independent predictors of the presence of intra-adrenal metastases. Conclusions None of the patient or tumour characteristics evaluated reliably predicted the likelihood of adrenal metastases in patients with no evidence of disseminated metastatic spread. However, previously published data indicate that the frequency of metachronous metastases within the contralateral kidney (1.8-3.8%) is significantly higher than the risk of a preoperatively undetected isolated intra-adrenal metastatic lesion when currently available imaging modalities are applied. Therefore, routine adrenalectomy should not be recommended if the preoperative radiological examinations are normal.

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“…Multiple reports from many centers throughout the world confirm that nephronsparing surgery (NSS) has been widely implemented for the management of small renal tumors over the last few decades (253)(254)(255)(256)(257)(258)(259)(260)(261)(262)(263)(264). There are several reasons for this (265).…”

Section: Introductionmentioning

confidence: 99%

Precancerous Lesions in the Kidney

Poppel

Nilsson

Algaba

et al. 2000

Scandinavian Journal of Urology and Nephrology

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Scand J Urol Nephrol Suppl 205: 136-165, 2000 Renal cell carcinoma (RCC), although occurring less frequently than prostate and bladder cancer, is actually the most malignant urologic disease, killing >35% of affected patients. Therefore, investigation of the nature of premalignant lesions of the kidney is a relevant issue. Following the most recent histological classification RCC can be subdivided into four categories: conventional RCC; papillary RCC; chromophobe RCC; and collecting duct carcinoma.In contrast to many genitourinary malignancies, premalignant alterations in the kidney are scarcely described. Intratubular epithelial dysplasia has been recognized as the most common precursor of RCC. In analogy to prostatic intraepithelial neoplasia (PIN), the premalignant lesions of the kidney are described as high or low-grade renal intratubular neoplasia. In contrast, precancerous lesions have been described as part of the von Hippel-Lindau syndrome (VHL) where the evolution from a simple cyst to an atypical cyst with epithelial hyperplasia to cystic or solid conventional-type RCC is well documented. Finally, in the genesis of papillary RCC an adenoma-carcinoma sequence has been recognized with specific genetic changes. There are no data on the epidemiology of premalignant lesions of the kidney, but research into the etiology of RCC has been extended substantially. Familial and genetic factors are well documented in VHL disease, in hereditary papillary RCC, in the tuberous sclerosis complex and in familial RCC. Cigarette smoking and obesity are established risk factors for RCC. Hypertension or its medication has also been associated with an increased risk. Among dietary factors an inverse relation between risk and consumption of vegetables and fruit has been found. Occupational exposure to substances such as asbestos and solvents has been linked to an increased risk of RCC.Specific RCC variants have distinctive chromosome alterations and several genes have been implicated in the development of RCC. Loss of material from the 3p chromosome characterizes conventional RCC and the deletion of the VHL suppressor gene plays an important role in the genesis of this RCC variant. In contrast, numerical changes with trisomy of chromosomes 7 and 17 and loss of the sex chromosome are typical changes in papillary tumors, whereas papillary RCC have additional trisomies. Chromophobe RCC is characterized by loss of chromosomes with a combination of monosomies. Less consistent genetic alterations are associated with collecting duct carcinoma.The traditional treatment of RCC is surgery by radical or partial nephrectomy. The latter approach carries a risk of tumor recurrence as a result of unrecognized satellite lesions or premalignant lesions that might have been present at the time of surgery. However, the reported recurrence rates after partial nephrectomy are <1% and therefore the possible presence of premalignant disease does not alter the actual treatment strategy advocated. Although multifocality and bilateral occurrence of...

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Conservative Surgery of Renal Cell Carcinoma

Cited by 26 publications

References 0 publications

Impact of resection margin status after nephron‐sparing surgery for renal cell carcinoma

Impact of resection margin status after nephron‐sparing surgery for renal cell carcinoma

The need for routine adrenalectomy during surgical treatment for renal cell cancer: the Hannover experience

Precancerous Lesions in the Kidney

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