Partial Nephrectomy Does Not Compromise Survival in Patients With Pathologic Upstaging to pT2/pT3 or High-grade Renal Tumors Compared With Radical Nephrectomy

Weight, Christopher J.; Lythgoe, Casey; Unnikrishnan, Raman; Lane, Brian R.; Campbell, Steven C.; Fergany, Amr

doi:10.1016/j.urology.2010.11.058

Cited by 60 publications

(32 citation statements)

References 21 publications

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“…1, p = 0.27), concurrent with other findings. 29 Importantly, one might expect a worse clinical outcomes after laparoscopy for pT3 renal masses PFS: progression-free survival; LRN: laparoscopic radical nephrectomy; LPN: laparoscopic partial nephrectomy; N/A: not available; aMedian time to progression not assessed due to a greater than 50% survival rate at the end of the follow-up period.…”

Section: Discussionmentioning

confidence: 99%

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

Nayak

Patel

Bjazevic

et al. 2015

CUAJ

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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.

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Section: Discussionmentioning

confidence: 99%

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

Nayak

Patel

Bjazevic

et al. 2015

CUAJ

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“…However, there was no difference in cancer specific survival between RN and PN when stratified by age, tumor size or grade. 14,16,27,28,30,35,36,61,62,66,67,71,73,74 Three studies assessed cancer specific survival for nonsurgical management vs RN and PN. 67-69 RN and PN resulted in statistically significant improved cancer specific survival compared to nonsurgical treatment in 2 SEER-Medicare studies of patients with clinical stage T1a tumors (hazard ratio for cancer specific mortality 0.58 to 0.62 and 0.42 to 0.45 for RN and PN, respectively, compared to nonsurgical treatment).…”

Section: Cancer Specific Survivalmentioning

confidence: 99%

mentioning

confidence: 99%

Management of Renal Masses and Localized Renal Cancer: Systematic Review and Meta-Analysis

et al. 2016

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Purpose-Several options exist for management of clinically localized renal masses suspicious for cancer, including active surveillance, thermal ablation and radical or partial nephrectomy. We summarize evidence on effectiveness and comparative effectiveness of these treatment approaches for patients with a renal mass suspicious for localized renal cell carcinoma. Materials and Methods-We searched MEDLINE®, Embase® and the Cochrane CentralRegister of Controlled Trials from January 1, 1997 through May 1, 2015. Paired investigators independently screened articles to identify controlled studies of management options or cohort studies of active surveillance, abstracted data sequentially and assessed risk of bias independently. Strength of evidence was graded by comparisons.Results-The search identified 107 studies (majority T1, no active surveillance or thermal ablation stratified outcomes of T2 tumors). Cancer specific survival was excellent among all management strategies (median 5-year survival 95%). Local recurrence-free survival was inferior for thermal ablation with 1 treatment but reached equivalence to other modalities after multiple treatments. Overall survival rates were similar among management strategies and varied with age and comorbidity. End-stage renal disease rates were low for all strategies (0.4% to 2.8%). Radical nephrectomy was associated with the largest decrease in estimated glomerular filtration rate and highest incidence of chronic kidney disease. Thermal ablation offered the most favorable perioperative outcomes. Partial nephrectomy showed the highest rates of urological complications but overall rates of minor/major complications were similar among interventions. Strength of evidence was moderate, low and insufficient for 11, 22 and 30 domains, respectively. * Correspondence: 600 N. Wolfe St., Park Building, Room 223, Baltimore, Maryland 21287 (telephone: 618-534-4942; FAX: 410-502-7711; hitenpatel@jhmi.edu). No direct or indirect commercial incentive associated with publishing this article.The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number.References 51 through 88 can be obtained at http://jurology.com/. HHS Public Access METHODS Data Sources and SearchesWe report results from a broader systematic review. Data Synthesis and AnalysisAll studies were summarized qualitatively. LRFS was defined as the absence of any persistent or recurrent disease in the treated region of the kidney or associated renal fossa after a single, curative intent initial treatment. This definition included persistent enhancement of any treated mass, a visually e...

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“…39 These benefits may extend to patients with clinically classified T1 tumors that are pathologically upstaged to T2 or T3 tumors. 40 Nevertheless, studies of national trends in PN use have demonstrated slow diffusion of this important surgical technique for patients with small renal masses. 6,40,41 Financial disincentives may dissuade general practice urologists from offering PN and RC.…”

Section: Discussionmentioning

confidence: 99%

“…40 Nevertheless, studies of national trends in PN use have demonstrated slow diffusion of this important surgical technique for patients with small renal masses. 6,40,41 Financial disincentives may dissuade general practice urologists from offering PN and RC. Medicare reimbursement rates for RC, including adjustments for inflation, declined by 32% from 1995 to 2004.…”

Section: Discussionmentioning

confidence: 99%

412 Identification of Underserved Areas for Urologic Cancer Care

et al. 2012

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Partial Nephrectomy Does Not Compromise Survival in Patients With Pathologic Upstaging to pT2/pT3 or High-grade Renal Tumors Compared With Radical Nephrectomy

Cited by 60 publications

References 21 publications

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

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

Management of Renal Masses and Localized Renal Cancer: Systematic Review and Meta-Analysis

412 Identification of Underserved Areas for Urologic Cancer Care

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