Management of small unilateral renal cell carcinomas: Radical versus nephron-sparing surgery

Butler, Brian P.; Novick, Andrew C.; Miller, David P.; Campbell, S.; Licht, Mark R.

doi:10.1016/s0090-4295(95)96306-5

Cited by 348 publications

(141 citation statements)

References 29 publications

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“…Furthermore, as we gained longer follow-up on these patients, multiple studies demonstrated equivalent oncologic outcomes with similar complication rates for the treatment of T1a tumours. 31,55 Concurrently, PN was demonstrated as superior to RN with regards to its nephronsparing benefits and better preservation of renal function. Further associations were then described between the preservation of renal function and long-term outcomes of cardiac morbidity and overall survival.…”

Section: The Current Standard -Partial Nephrectomymentioning

confidence: 99%

“…28 Indications for PN have since broadened as the safety and the benefits of this approach have become increasingly apparent. [29][30][31] The benefit of this approach is that it allows for the adequate removal of the kidney tumour, while preserving as much renal parenchyma as possible. In appropriately selected patients, PN is associated with equivalent 10-year disease-free survival and local recurrence rates when compared to RN.…”

Section: Partial Nephrectomymentioning

confidence: 99%

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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

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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

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Section: The Current Standard -Partial Nephrectomymentioning

confidence: 99%

Section: Partial 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

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“…There was an inconsistency in the direction of effect: Butler [30] reported 75% vs. 80%; whilst Lee [31] reported 98.2% vs. 88.8% (p = 0.63) ( Table 2) for open partial vs. open radical nephrectomy respectively. However, these estimates should be interpreted with caution as data were available for a shorter follow-up period in partial nephrectomy cases (40 ±26 months) than in radical nephrectomy cases (66±30 months) (Butler, 1995) [30]. In addition, neither study was randomised and prognostically important covariates, such as tumour grade and cell type were not reported.…”

Section: 24a Partial Nephrectomy Vs Radical Nephrectomy I Open mentioning

confidence: 99%

“…One RCT (D'Armiento 1997) [29], a prospective cohort study (Gratzke, 2007) [20], a database review (Butler, 1995) [30] and one retrospective matched pair study (Lee, 2007) Gratzke's [20] study does not give any information on tumour size but T1-T2 patients were included. However there were prognostically relevant baseline imbalances in the radical vs. partial nephrectomy tumour stages (see Table 1).…”

Section: 24a Partial Nephrectomy Vs Radical Nephrectomy I Open mentioning

confidence: 99%

“…In addition, neither study was randomised and prognostically important covariates, such as tumour grade and cell type were not reported. The estimated cancer-specific survival rates at 5 years for radical versus partial nephrectomy respectively were 97% versus 100% [30] and 97.9% versus 100% (p = 0.98) [31] ( Table 2).…”

Section: 24a Partial Nephrectomy Vs Radical Nephrectomy I Open mentioning

confidence: 99%

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

MacLennan

Imamura

Lapitan³

et al. 2012

European Urology

304

174

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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.

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Adenocarcinoma of the kidney: Nephron-sparing surgical approach vs. radical nephrectomy

et al. 1999

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Management of small unilateral renal cell carcinomas: Radical versus nephron-sparing surgery

Cited by 348 publications

References 29 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

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

Adenocarcinoma of the kidney: Nephron-sparing surgical approach vs. radical nephrectomy

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