Radical Nephrectomy for pT1a Renal Masses May be Associated With Decreased Overall Survival Compared With Partial Nephrectomy

Thompson, R. Houston; Boorjian, Stephen A.; Lohse, Christine M.; Leibovich, Bradley C.; Kwon, Eugene D.; Cheville, John C.; Blute, Michael L.

doi:10.1016/j.juro.2007.09.077

Cited by 629 publications

(375 citation statements)

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“…Thompson et al first reported that radical nephrectomy was associated with decreased survival in patients who had a single renal cortical tumor 4 cm compared with partial nephrectomy, suggesting that this effect might be related to a loss of renal function that outweighed any oncologic benefit. 16 Pettus et al subsequently reported that moderate and severe renal dysfunction before surgery were associated with decreased overall survival in patients undergoing partial or radical nephrectomy. 17 Hollingsworth et al, in a population-based competing risk analysis, demonstrated that the competing-cause mortality for elderly patients (aged 70 years) was 28% and concluded that active surveillance might be a reasonable strategy for some tumors.…”

Section: Discussionmentioning

confidence: 99%

“…It has been demonstrated that both open and laparoscopic partial nephrectomy produce superior functional outcomes and oncologic outcomes that are at least equivalent to the outcomes produced after radical nephrectomy for selected tumors. 16,[19][20][21][22] Percutaneous tumor ablation and active surveillance are considered for patients who may be poor surgical candidates. Although it is not quite as effective as partial nephrectomy, approximately 80% of patients are disease-free after thermal ablation, and this remains a valid nephron-sparing intervention for this age group.…”

Section: Discussionmentioning

confidence: 99%

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Active treatment of localized renal tumors may not impact overall survival in patients aged 75 years or older

Lane

Abouassaly

Gao

et al. 2010

Cancer

239

138

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BACKGROUND: Although nephrectomy cures most localized renal cancers, this oncologic benefit may be outweighed by the renal functional costs of such an approach. In this study, the authors examined overall survival in 537 patients who had localized renal tumors 7 cm detected at age 75 years to investigate whether surgical intervention improved survival compared with active surveillance. METHODS: Clinical T1 renal tumors were managed with surveillance (20%), nephron-sparing interventions (53%), or nephrectomy (27%). Cox regression models were constructed based on age, comorbidity, management type, renal function, and other variables. RESULTS: The median follow-up was 3.9 years, and death from any cause occurred in 148 patients (28%). The most common cause of death was cardiovascular (29%), and cancer progression was responsible in only 4% of deaths. Kaplan-Meier analysis revealed decreased overall survival for patients who underwent surveillance and nephrectomy relative to nephron-sparing intervention (P ¼ .01); however, surveilled patients were older and had greater comorbidity. In multivariate analysis, significant predictors of overall survival included age (P ¼ .0004) and comorbidity (P < .0001) but not management type (P ¼ .3). Preoperative renal function (P ¼ .006) and comorbidity (P ¼ .005) were predictors of cardiovascular mortality, and nephrectomy was associated with greatest loss of renal function. CONCLUSIONS: In patients aged 75 years, surgical management of clinically localized renal cortical tumors was not associated with increased survival. Patients died mostly of cardiovascular causes, similar to the general elderly population. Nephrectomy accelerated renal dysfunction, which was associated with cardiovascular mortality. Current paradigms suggest that there is over treatment of localized renal tumors, and further study will be required to evaluate the advisability of various options in patients with limited life expectancy. Cancer 2010;116:3119-26.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Active treatment of localized renal tumors may not impact overall survival in patients aged 75 years or older

Lane

Abouassaly

Gao

et al. 2010

Cancer

239

138

View full text Add to dashboard Cite

show abstract

“…However, the importance of nephron-sparing surgery focuses not only on avoiding chronic renal insufficiency, but also to decrease the incidence of cardiovascular events and death. 8,9,10 Therefore, in patients with a renal mass ≤ 4cm (cT1a), partial nephrectomy is the new gold standard. It has even been suggested that tumors <7cm (cT1b) should be managed with parital nephrectomy when surgically feasible.…”

Section: Review Of Management Options For the Ct1 Renal Massmentioning

confidence: 99%

“…The majority of the urologic literature has demonstrated that most small RCNs have a slow growth rate (GR) and low risk of metastasis. 10 A summary of the contemporary AS series (820 tumors) show a growth rate of 0.27cm/year with 21% undergoing delayed intervention (Table 1). Only 12 (1.6%) lesions progressed to metastatic disease with only 1 cancer specific death.…”

Section: Review Of Management Options For the Ct1 Renal Massmentioning

confidence: 99%

Active Surveillance for Renal Cortical Neoplasms

et al. 2010

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“…Bununla birlikte KBH olan hastalarda kardiyovasküler mortalite, KBH olmayanlara göre daha fazladır (32/1.000'e karşı 16/1.000) (8). Genç (<65 yaş) ve küçük renal kitleli (<4 cm) hastalarda RN ile NKC karşılaştırıldığında, RN'nin daha kısa genel sağkalım ile ilişkili olduğu gösterilmiştir (9). Görüntüleme ve ameliyat tekniklerindeki bu gelişmeler sonucunda günümüzde RHK hastalarında onkolojik başarı artık tek başına başarı olarak kabul edilemez.…”

Section: Introductionunclassified

The Effects of Radical Nephrectomy and Nephron Sparing Surgery on Glomerular Filtration Rate for the Patients who Underwent Surgery for Localized Renal Mass

Güdeloğlu¹,

Akdoğan²

2016

Acta Oncol Tur.

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ÖZETAmaç: Bu çalışmada, radikal nefrektomi (RN) ile nefron koruyucu cerrahinin (NKC) uzun dönem böbrek fonksiyonları üzerine etkisini ortaya koymak amaçlanmıştır. Hastalar veYöntem: Hacettepe Üniversitesi Tıp Fakültesi Üroloji Anabilim Dalı'nda Ocak 1990 -Nisan 2011 tarihleri arasında renal kitle nedeniyle ameliyat edilen 1016 hastaya ait veriler, retrospektif olarak incelenmiştir. Tanı anında metastatik olduğu bilinen 78 olgu çalışma dışı tutulmuştur. Bulgular: Çalışmaya alınan olguların 579'u (%61,7) erkek ve 359'u (%38,3) kadındır. 624 olguya RN, 314 olguya NKC yapılmıştır. Hastaların ortalama takip süresi RN yapılan grupta 46.7 ay iken, NKC uygulanan grupta 39.9 aydır. Ortalama radyolojik tümör boyutu sırasıyla 75±33,5 mm ve 37,8±26 mm'dir (p<0.001). Ortalama ameliyat süresi RN ve NKC grupları için sırasıyla 137.6 ve 139.5 dakikadır. NKC uygulanan grupta ortalama sıcak iskemi süresi 18,9±6,8 (3-36) dakikadır. Uzun dönem takip sonunda RN yapılan gruptaki kreatinin değerindeki ortalama 0,51 mg/dl artış, NKC uygulanan gruptaki 0,39 mg/dl artıştan anlamlı şekilde daha fazladır (p<0.001). Uzun dönem takipte preoperatif GFR'ı ≥60 olan hastaların halen GFR değerinin ≥60 olarak devam etme oranları, RN ve NKC yapılan gruplarda sırasıyla %47.6 ve %74.8 olarak tespit edilmiştir (p<0.001). Sonuç: Çalışmamızda GFR'de azalma oranının uzun dönemde RN yapılan hastalarda NKC yapılanlara göre daha fazla olduğu bulunmuştur. T1 renal tümörü olan birçok olguda RN ile bütün böbreği çıkarmak fazladan tedavidir. T1 renal tümörü olan hastalarda teknik olarak mümkün oldukça parsiyel nefrektomi tercih edilmelidir. Anahtar kelimeler: Renal Hücreli Karsinom, Radikal Nefrektomi, Nefron Koruyucu Cerrahi, Glomerüler Filtrasyon Oranı ABSTRACT Objectives: The goal of this study was to demonstrate the long-term effects of radical nephrectomy (RN) and nephron sparing surgery (NSS) on kidney functions. Patients and Methods: The medical records of 1016 patients who underwent kidney surgery from January 1990 to April 2011 at Hacettepe University School of Medicine, Department of Urology were retrospectively collected and analyzed. Metastatic 78 patients at presentation were excluded. Results: Radical nephrectomy and nephron sparing surgery was performed in 624 and 314 cases, respectively. Male to female ratio was 579/314. The mean follow up was 46.7 and 39.9 months for RN and NSS, respectively. The mean radiological tumor size was 75±33,5 mm for RN and 37,8±26 mm for NSS (p<0.001). The mean duration of surgery for RN and NSS was 137 and 139 minutes, respectively. The mean warm ischemia time for NSS was 18.9 minutes. Serum creatinin level was increased 0.51mg/dl and 0.39mg/dl for RN and NSS after long-term follow up, respectively (p<0.001). Glomerular filtration rate (GFR) was ≥ 60 ml/min/m 2 in 47.6% and 74.8% of RN and NSS patients in long-term follow up, respectively (p<0.001). Conclusion: Decrease in GFR was more prominent in RN compared to NSS patients in long term. Therefore, removing the whole kidney for especially T1 renal tumours is over ...

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Radical Nephrectomy for pT1a Renal Masses May be Associated With Decreased Overall Survival Compared With Partial Nephrectomy

Abstract: Our results suggest that, compared with partial nephrectomy, radical nephrectomy is associated with decreased overall survival in younger patients with small renal masses.

Cited by 629 publications

References 21 publications

Active treatment of localized renal tumors may not impact overall survival in patients aged 75 years or older

Active treatment of localized renal tumors may not impact overall survival in patients aged 75 years or older

Active Surveillance for Renal Cortical Neoplasms

The Effects of Radical Nephrectomy and Nephron Sparing Surgery on Glomerular Filtration Rate for the Patients who Underwent Surgery for Localized Renal Mass

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