Results after Organ-Preserving Surgery for Renal Cell Carcinoma

Ph, Petritsch; Rauchenwald, Michael; Zechner, O.; Ludvik, W; Pummer, Karl; Urlesberger, H; Eberle, Joe; Joos, H.; Kaufman, Francine; Kugler, Walter

doi:10.1159/000463879

Cited by 45 publications

(25 citation statements)

References 8 publications

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“…In accordance with the results of our study, the need for a more conservative approach to small, peripherally located tumors has been confirmed in the recent literature [13,16]. In an Austrian Multicenter Study including 52 patients with an elective indication for conservative surgery the survival rate was comparable to results after radical nephrectomy in patients with low-stage tumors [16]. However, the renal cell carcinoma is an unpredictable tumor that has been known to recur as late as 13 years after the first operation [25], and that may remain stable for a period of 35 years when untreated [7]; therefore, all results should be cautiously interpreted.…”

Section: Discussionsupporting

confidence: 92%

“…Only one patient in this group developed metastases; it can be assumed that occult metastases were already present preoperatively. In accordance with the results of our study, the need for a more conservative approach to small, peripherally located tumors has been confirmed in the recent literature [13,16]. In an Austrian Multicenter Study including 52 patients with an elective indication for conservative surgery the survival rate was comparable to results after radical nephrectomy in patients with low-stage tumors [16].…”

Section: Discussionsupporting

confidence: 90%

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Parenchyma-sparing surgery for renal tumors

Stöckle¹,

Thüroff²,

Störkel³

et al. 1991

World J Urol

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Between 1969Between und 1989 conservative surgery for kidney tumors was performed in 123 patients. In 49 patients there was an imperative indication for a parenchyma-sparing operation because nephrectomy would have made dialysis obligatory. Thirty-five of these 49 patients show no signs of tumor progression after a mean follow-up of 4.5 years. Known metastases were present in 3 of 6 patients who died as a result of their tumors. In two patients there was a recurrence after 1 and 5 years, respectively, requiring a second organ-preserving operation. In one further patient we suspect that multiple small tumor lesions may be present 2 years after the first operation. In 74 patients with a healthy contralateral kidney the tumor was enucleated by choice (elective indication). Sixty-eight of these 74 patients show no signs of tumor progression after a mean follow-up period of 3.3 years. One patient died from tumor metastases. Two patients had tumor recurrence, requiring nephrectomy and enucleation, respectively. Fifty-seven enucleated tumors were available for image analysis DNA cytometry. Only the two patients with a hypertriploid tumor died from their cancer.Until now radical nephrectomy has been regarded as standard therapy for non-metastasized renal cell carcinoma [15,18,21]. This operation has been accepted because of its theorized advantage of more complete resection. A parenchyma-sparing operation has only been performed on patients in whom radical nephrectomy would result in renal failure requiring hemodialysis (imperative indication), such as those with a single kidney, bilateral tumors, dysfunctional contralateral kidney or chronic renal failure. However, the widely used partial nephrectomy in these instances may result, in certain cases, in insufficient residual renal parenchyma [14]. Simple enucleation of the tumor, together with a small surrounding margin of normal renal tissue, is an alternative technique to this * To whom correspondence should be addressed approach. The surprisingly good prognosis of patients, which were treated by enucleation in the imperative group [1], encouraged us over the past 9 years to perform parenchyma-sparing operations also on patients with small peripheral tumors and normal contralateral kidneys (elective indication). In addition, these small and mostly asymptomatic kidney tumors, which only a few years ago were rarely diagnosed, are being detected more frequently by ultrasound. Thus, the incidence of asymptomatic renal tumors increased from 10% in 1978 to 70°70 in 1989, while the classic symptoms of flank pain, hematuria and palpable mass were found in less than 10% of the cases, Here we present the operative technique, complications, patient outcome and preliminary results of image analysis DNA cytometry. Between 1969 and, conservative surgery of kidney tumors was performed in 123 patients. Conservative surgery was imperative for 49 of the patients (18 female, 31 male) aged 38 to 77 years (average age 59 years). A total of 23 patients had metachronous or synchronous bila...

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 90%

Parenchyma-sparing surgery for renal tumors

Stöckle¹,

Thüroff²,

Störkel³

et al. 1991

World J Urol

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“…The concept of a kidney-sparing approach for such small renal tumors is supported by several arguments: (1) the preoperative unknown malignant potential of solid renal tumors, (2) a well-defined tumor pseudocapsule, (3) a possible impairment or loss of renal function in the remaining contralateral kidney after radical nephrectomy, (4) the risk of developing a metachronous contralateral RCC, and (5) the possible need for cytotoxic treatment of metastatic disease in the future [29]. Recently, a growing number of authors have reported excellent results with nephron-~par-ing surgery in this situation [11,12,18,21,28]. A review article from Licht et al detailed the outcome of nephronsparing surgery in 241 reported patients with unilateral localized RCC and a normal contralateral kidney.…”

Section: Nephron-sparing Surgery In the Presence Of A Normal Contralamentioning

confidence: 99%

Current controversies in nephron-sparing surgery for renal-cell carcinoma

Steinbach¹,

Stöckle²,

Hohenfellner³

1995

World J Urol

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The role of nephron-sparing surgery for renal cell carcinoma is well established in patients with an anatomical or functional solitary kidney (imperative indication) in which a radical nephrectomy would render the patient anephric with subsequent need for hemodialysis. This also encompasses patients with a unilateral renal cell carcinoma and a functioning contralateral kidney when the opposite renal unit is affected by a disease that might threaten its future function, such as renal artery stenosis, chronic pyelonephritis, stone disease or systemic conditions such as diabetes. A functioning renal remant of at least 20% of normal renal parenchyma seems to be necessary to avoid end-stage renal failure in these patients [16]. There have been several reports in the literature of excellent 5-year cancer-specific survival rates of over 80% in such circumstances [12, 15]. These results were confirmed in our institution, with a 5-year cancer-specific survival rate of 83% in over 70 patients with an imperative indication for nephron-sparing surgery. Thereby the prognosis was significantly influenced by the local tumor stage and the grade of malignancy. These data support the efficacy of nephron-sparing surgery in this clinical situation.

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“…However, in patients with bilateral synchronous RCC, with a solitary kidney, or with significant contralateral kidney disease, a renal parenchyma-preserving procedure rather than radical nephrectomy is used [2]. Conservative surgery for RCC has provided excellent oncological results in imperative and then elective indications [3][4][5][6][7][8][9]. Local tumor recurrence and its possible impact on survival are the major concerns.…”

Section: Introductionmentioning

confidence: 99%

Enucleoresection for the Elective Treatment of Small Renal Cell Carcinoma: Can It Be the Treatment of Choice?

Adamakis¹,

Koutalellis²,

Mitropoulos³

et al. 2007

Oncol Res Treat

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Background: We present our findings in a series of T1 renal cell carcinomas (RCC) treated with excision of the tumor surrounded by a minimal layer of grossly normal parenchyma. Patients and Methods: A total of 43 patients who underwent elective nephron-sparing surgery performed with enucleoresection were studied retrospectively. None of the patients had preoperative or intraoperative suspicion of positive nodes and were free from distant metastases before surgery (N0, M0). Patients status was last evaluated in January 2006. Results: Median age was 58.7 years (35-78). Median tumor size was 3.3 cm (1.5-7). There were no major complications such as bleeding and urinary leakage/ urinoma requiring re-operation. Pathological stage was pT1a in 38 (89%), pT1b in 4 (9%) and pT3a in 1 (2%) patient. Median followup was 32 months (6-89). A total of 5 patients with RCC had died as of January 2006. Overall, 3 (6.9%) patients had disease progression, of whom 2 (4.6%) were local recurrence, 1 alone and 1 associated with distant metastases. The overall cancer-specific survival was 95.4%, and the overall progression-free survival was 93%. Conclusions: Enucleoresection reproduces the results of partial and radical nephrectomy with minimal morbidity. It is a safe and acceptable approach for elective nephronsparing surgery.

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Results after Organ-Preserving Surgery for Renal Cell Carcinoma

Cited by 45 publications

References 8 publications

Parenchyma-sparing surgery for renal tumors

Parenchyma-sparing surgery for renal tumors

Current controversies in nephron-sparing surgery for renal-cell carcinoma

Enucleoresection for the Elective Treatment of Small Renal Cell Carcinoma: Can It Be the Treatment of Choice?

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