Nephron-sparing surgery is superior to radical nephrectomy in preserving renal function benefit even when expanding indications beyond the traditional 4-cm cutoff

Pignot, G.; Bigot, Pierre; Bernhard, Jean-Christophe; Boulière, Fabien; Bessède, Thomas; Bensalah, Karim; Salomon, Laurent; Mottet, Nicolas; Bellec, L.; Soulié, M.; Ferrière, J.; Pfister, Christian; Drai, J.; Colombel, Marc; Villers, Arnauld; Rigaud, J.; Bouchot, Olivier; Montorsi, Francesco; Bertini, Roberto; Belldegrun, Arie S.; Pantuck, Allan J.; Patard, Jean Jacques

doi:10.1016/j.urolonc.2014.03.012

Cited by 27 publications

(17 citation statements)

References 30 publications

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“…The loss of renal function is decreased following PN compared with that following radical nephrectomy (RN), and oncological management is reportedly equivalent between PN and RN (1,4). Although patients following RN are not likely to exhibit severe renal dysfunction requiring hemodialysis (5,6), 65% of patients develop grade 3 chronic kidney disease, defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m 3 , 3 years after nephrectomy (7) and the decrease in eGFR may lead to an increased risk of cardiovascular-related death in the future (8,9).…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of percutaneous radiofrequency ablation for small renal cancer

et al. 2017

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Abstract. Partial nephrectomy is the treatment of choice for small renal cell carcinoma (RCC) from the perspective of cancer management and renal function. However, when patients with RCC are of advanced age, exhibit severe comorbidities, including cardiovascular and pulmonary diseases, or have hereditary RCC, ablative therapies, including radiofrequency ablation (RFA) and cryoablation are useful treatment options. In the present study, the clinical outcomes of percutaneous RFA for treating small RCC were evaluated. Between December 2005 and March 2015, 40 patients (41 renal tumors in total) underwent RFA and a total of 50 sessions of RFA were performed. The average tumor size was 2.5 cm. A total of 18 tumors were exophytic and 23 were parenchymal. Of the 41 tumors, 85.4% were completely ablated by initial RFA and the rate of complete ablation following reablation for residual viable lesions was 95.1%. Local recurrence-free survival following complete ablation was 84.2% at 3 years. A patient with a 4.7 cm RCC tumor rapidly progressed following four RFA treatments until complete ablation was achieved. The metastasis-free survival rate following initial RFA was 95.7% at 3 years. The RCC-specific survival was 100% (mean follow-up, 38 months). Adverse events occurred in five sessions (10%); however, only 1 patient with arteriovenous fistula required intervention (transarterial embolization). The mean hospital stay following RFA was 3.2 days. The mean decrease in estimated glomerular filtration rate following RFA was 2.7%. The results of the present study indicate that percutaneous RFA was an effective treatment for small RCCs with respect to management of cancer, minimal invasiveness and minimal loss of renal function, particularly in patients for whom surgery would be a high risk and those at increased risk of deterioration of renal function.

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Section: Introductionmentioning

confidence: 99%

Clinical outcomes of percutaneous radiofrequency ablation for small renal cancer

et al. 2017

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“…Tumor location also plays a key role in the RENAL nephrometry score system, which has been shown to be a strong prognostic predictor [8]. Similarly, preoperative GFR has been demonstrated to significantly affect renal function decrease [16]; and it has been reported that the benefit of partial nephrectomy only exists in patients with good preoperative eGFR [17]. …”

Section: Discussionmentioning

confidence: 99%

Nephron Sparing Surgery Has Better Oncologic Outcomes Than Extirpative Nephrectomy in T1a but Not in T1b or T2 Stage Renal Cell Carcinoma

et al. 2017

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BackgroundThe aim of this study was to investigate the benefit of nephron sparing surgery (NSS) compared with extirpative nephrectomy in different tumor stages of renal cell carcinoma.Material/MethodsWe reviewed the Surveillance, Epidemiology and End Results (SEER) database for NSS and extirpative nephrectomy in localized (stages T1–2N0M0) renal cell carcinoma diagnosed after 2004. We used the variable screening function of the SEER database to identified 55,947 cases that met inclusion and exclusion criteria for survival analysis. Overall mortality and cancer-specific mortality were the primary index outcomes. Stratification analysis was done by T stage subgroups. We also performed survival analysis using propensity score analysis, and changed the survival model to the competing-risk model for cancer-specific mortality analysis.ResultsOverall, NSS significantly decreased the risk of overall mortality (HR 0.717, 0.668–0.769) and cancer-specific mortality (HR 0.604, 0.525–0.694) when compared to extirpative nephrectomy. In subgroup analysis, NSS had a lower overall mortality risk and cancer-specific mortality compared to extirpative nephrectomy only for T1a stage renal cell carcinoma (HR 0.654, 0.599–0.714, p<0.01 and HR 0.554, 0.458–0.670, p<0.01, respectively), but not for T1b or T2 stage. The propensity score analysis, which included standardized mortality ratio weight adjustment, showed the same results. Additionally, for cancer-specific mortality, a competing-risk model gave the exactly same outcome.ConclusionsCompared to extirpative nephrectomy, NSS provided superior overall survival and cancer-specific survival for localized renal cell carcinoma only in T1a stage, not in T1b or T2 stage. NSS should be recommended when the surgery is possible. Further prospective study is needed to confirm this result.

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“…Using 2010 data on the acquisition and maintenance costs of the da Vinci Surgical System and on the intensity of its use in nephrectomy in each HRR, 12,50 and assuming a five-year life for the equipment, 51 we estimated an annual cost of $113,000 per HRR to acquire and maintain a robot-assisted system for kidney cancer.…”

Section: Discussionmentioning

confidence: 99%

“…11 In 2010 a robot-assisted surgery system cost $1.0-$2.3 million to acquire and $100,000-$170,000 annually to maintain. 2,12 Some observers have questioned whether the up-front investment may increase overall procedure costs and lead hospitals to increase charges to payers. 11,[13][14][15] There has also been concern that the availability of surgical robots encourages providers to perform procedures on inappropriate patients.…”

Section: Robot-assisted Surgery For Kidney Cancer Increased Accessmentioning

confidence: 99%

“…19 However, a consensus is emerging that partial nephrectomy is superior for appropriate patients. 12,[20][21][22] During the past decade there has been a dramatic increase in the availability of robotassisted minimally invasive surgery systems to treat kidney cancer. [1][2][3] This provides a basis for determining the costs and benefits of robotassisted surgery systems in nephrectomies for kidney cancer.…”

Section: Robot-assisted Surgery For Kidney Cancer Increased Accessmentioning

confidence: 99%

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Robot-Assisted Surgery For Kidney Cancer Increased Access To A Procedure That Can Reduce Mortality And Renal Failure

Chandra

Snider

Wu³

et al. 2015

Health Affairs

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Surgeons increasingly use robot-assisted minimally invasive surgery for a variety of medical conditions. For hospitals, the acquisition and maintenance of a robot requires a significant investment, but financial returns are not linked to any improvement in long-term patient outcomes in the current reimbursement environment. Kidney cancer provides a useful case study for evaluating the long-term value that this innovation can provide. Kidney cancer is generally treated through partial or radical nephrectomy, with evidence favoring the former procedure for appropriate patients. We found that robot-assisted surgery increased access to partial nephrectomy and that partial nephrectomy reduced mortality and renal failure. The value of the benefits of robot-assisted minimally invasive surgery to patients, in terms of quality-adjusted life-years gained, outweighed the health care and surgical costs to patients and payers by a ratio of five to one. In addition, we found no evidence that the availability of robot-assisted minimally invasive surgery increased the likelihood that inappropriate patients received partial nephrectomy.

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Nephron-sparing surgery is superior to radical nephrectomy in preserving renal function benefit even when expanding indications beyond the traditional 4-cm cutoff

Cited by 27 publications

References 30 publications

Clinical outcomes of percutaneous radiofrequency ablation for small renal cancer

Clinical outcomes of percutaneous radiofrequency ablation for small renal cancer

Nephron Sparing Surgery Has Better Oncologic Outcomes Than Extirpative Nephrectomy in T1a but Not in T1b or T2 Stage Renal Cell Carcinoma

Robot-Assisted Surgery For Kidney Cancer Increased Access To A Procedure That Can Reduce Mortality And Renal Failure

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