Similar functional outcomes after partial nephrectomy for clinical T1b and T1a renal cell carcinoma

Iizuka, Junpei; Kondo, Tsunenori; Hashimoto, Yuichi; Kobayashi, Hirohito; Ikezawa, Eri; Takagi, Toshio; Omae, Kazuyuki; Tanabe, Kazunari

doi:10.1111/j.1442-2042.2012.03085.x

Cited by 17 publications

(15 citation statements)

References 24 publications

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“…On the other hand, a prospective study from Van Poppel et al [19] demonstrated inferior 10-year OS rates in PN patients compared to RN patients. In this study, in accordance to the contemporary literature [15][16][17] , we found superior survival rates for PN patients compared to RN patients in the study collective. Based on these reports and our own results, we confirm that PN is oncologically safe even in large RCCs.…”

Section: Discussionsupporting

confidence: 91%

Long-Term Outcome of Nephron-Sparing Surgery Compared to Radical Nephrectomy for Renal Cell Carcinoma ≥4 cm - A Matched-Pair Single Institution Analysis

Kalogirou

Fender²,

Muck³

et al. 2016

Urol Int

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Purpose: We investigated the long-term oncological and functional outcome of nephron-sparing surgery/partial nephrectomy (PN) versus radical nephrectomy (RN) for any renal cell carcinoma (RCC) ≥4 cm. Patients and Methods: Between 1997 and 2013, we identified 128 patients undergoing PN for RCC ≥4 cm and matched this collective to 128 patients undergoing RN. We then compared overall survival (OS), cancer-specific survival (CSS), progression-free survival (PFS) and functional parameters in both groups. The median follow-up time was 58 months (3-210 months). Results: Compared to RN, patients with a PN showed a significantly higher 10-year OS (77.0 vs. 63.0%, p = 0.04), CSS (90.6 vs. 71.7%, p = 0.002) and PFS (82.9 vs. 57.4%, p ≤ 0.001). Renal function preservation was better in the PN group (24 months estimated glomerular filtration rate: 68.2 ml/min for PN vs. 40.6 ml/min for RN, p ≤ 0.01) with significantly less new onset chronic kidney diseases. Total complication rate was comparable, whereas PN procedures showed more Clavien-Dindo grade I + II complications, portraying the technical challenge of PN in larger RCCs. Conclusions: Whenever feasible, PN should be considered for renal masses ≥4 cm, as this technique shows better long-term results regarding disease-specific survival and renal function preservation in our study group.

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Section: Discussionsupporting

confidence: 91%

Long-Term Outcome of Nephron-Sparing Surgery Compared to Radical Nephrectomy for Renal Cell Carcinoma ≥4 cm - A Matched-Pair Single Institution Analysis

Kalogirou

Fender²,

Muck³

et al. 2016

Urol Int

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“…NSS has been the therapeutic standard in a majority of patients with a T1a renal tumor, and the indication of NSS has recently been extended to selective T1b and T2 disease [3,4,5]. The surgical option for localized renal tumors largely depends on their anatomical features, and a classification or scoring system, which can quantitatively assess the anatomical feature of the tumor with high reproducibility, is thus warranted.…”

Section: Introductionmentioning

confidence: 99%

The RENAL Nephrometry Score and the PADUA Classification for the Prediction of Perioperative Outcomes in Patients Receiving Nephron-Sparing Surgery: Feasible Tools to Predict Intraoperative Conversion to Nephrectomy

Kobayashi¹,

Saito²,

Kitamura³

et al. 2013

Urol Int

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Objective: To evaluate the potential of the RENAL nephrometry score and the PADUA classification in the prediction of perioperative outcomes represented by intraoperative conversion to nephrectomy in patients with renal tumors for which nephron-sparing surgery (NSS) was attempted. Methods: Recent 100 open NSSs attempted for cT1 renal tumors at a single institution were studied retrospectively. Results: With the RENAL, the operation time and ischemia time were longer in the high complexity group (p = 0.01 and p = 0.03, respectively), and blood loss was seemingly greater in this group (394 vs. 220 and 167 ml, p = 0.09). Conversion to nephrectomy was more frequent in the high complexity (4 procedures, 33.3%) than in the low (0%) and moderate (1 procedures, 1.5%) groups (p < 0.01). Regarding the PADUA, the operation time, blood loss and ischemia time increased according to the complexity (p = 0.04, p = 0.02, and p = 0.02, respectively). Conversion to nephrectomy was more frequent in the high complexity (4 procedures, 22.2%) than in the low (0%) and moderate (1 procedure, 1.8%) groups (p < 0.01). In patients with achieved NSS, postoperative estimated glomerular filtration rate was more impaired in the high complexity group in the PADUA (p = 0.02), although not significant in the RENAL (p = 0.11). Conclusions: Both the RENAL and PADUA are useful in the prediction of conversion to nephrectomy in addition to NSS-associated perioperative outcomes.

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“…Institutional cohorts generally exhibited minimal difference in overall survival between RN and PN (low strength of evidence). 18,19,21,22,24,27,28,31,32,36,60,[86][87][88] Authors of studies with statistically significant OS advantage for PN acknowledged differences in baseline characteristics (ie selection bias) that may have contributed to the observed findings. 23,25,26,74 In 10 SEER studies comprising the majority of patients in this analysis PN was associated with a statistically significant overall survival benefit compared to RN for clinical stage T1a tumors but not for T1b tumors.…”

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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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Similar functional outcomes after partial nephrectomy for clinical T1b and T1a renal cell carcinoma

Cited by 17 publications

References 24 publications

Long-Term Outcome of Nephron-Sparing Surgery Compared to Radical Nephrectomy for Renal Cell Carcinoma ≥4 cm - A Matched-Pair Single Institution Analysis

Long-Term Outcome of Nephron-Sparing Surgery Compared to Radical Nephrectomy for Renal Cell Carcinoma ≥4 cm - A Matched-Pair Single Institution Analysis

The RENAL Nephrometry Score and the PADUA Classification for the Prediction of Perioperative Outcomes in Patients Receiving Nephron-Sparing Surgery: Feasible Tools to Predict Intraoperative Conversion to Nephrectomy

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

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