Surgical Management of Renal Tumors 4 Cm. Or Less in a Contemporary Cohort

LEE, CHERYL T.; Katz, Jared; Shi, Wei; Thaler, Howard T.; Reuter, Victor E.; Russo, Paul

doi:10.1097/00005392-200003000-00008

Cited by 158 publications

(204 citation statements)

References 34 publications

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“…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%

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%

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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show abstract

“…2 Because of the small size and early stage of these tumours, surgeons are able to do partial nephrectomies without compromising safety and oncological efficacy. 3,4 In tertiary-care centres in the USA, partial nephrectomy now accounts for 30-65% of all surgical procedures for renal cortical tumours. 5-7 However, this trend does not represent current US surgical practice for renal cortical tumours.…”

Section: Introductionmentioning

confidence: 99%

Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study

Huang

Levey

Serio

et al. 2006

The Lancet Oncology

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887

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“…1,2,4,11,12 In synchronicity with the gradual dissemination of laparoscopic radical nephrectomy, 2,4 multiple investigators reported that, for selected patients with smaller renal tumors, partial nephrectomy yields oncologic outcomes that are indistinguishable from the outcomes achieved by radical excision. [13][14][15] Partial nephrectomy also preserves long-term renal function 16,17 while reducing over-treatment of patients with benign 18 or clinically indolent 19 tumors.…”

mentioning

confidence: 99%

Diffusion of surgical innovation among patients with kidney cancer

Miller

Saigal

Banerjee

et al. 2008

Cancer

107

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BACKGROUNDDespite their potential benefits to patients with kidney cancer, the adoption of partial nephrectomy and laparoscopy has been gradual and asymmetric. To clarify whether this trend reflects differences in kidney cancer patients or differences in surgeon practice styles, the authors compared the magnitude of surgeon‐attributable variance in the use of partial nephrectomy and laparoscopic radical nephrectomy with that attributable to patient and tumor characteristics.METHODSBy using linked Surveillance, Epidemiology, and End Results‐Medicare data, the authors identified a cohort of 5483 Medicare beneficiaries who underwent surgery for kidney cancer between 1997 and 2002. Two primary outcomes were defined: 1) the use of partial nephrectomy and (2) the use of laparoscopy among patients undergoing radical nephrectomy. By using multilevel models, surgeon‐ and patient‐level contributions to observed variations in the use of partial nephrectomy and laparoscopic radical nephrectomy were estimated.RESULTSOf the 5483 cases identified, 611 (11.1%) underwent partial nephrectomy (43 performed laparoscopically), and 4872 (88.9%) underwent radical nephrectomy (515 performed laparoscopically). After adjusting for patient demographics, comorbidity, tumor size, and surgeon volume, the surgeon‐attributable variance was 18.1% for partial nephrectomy and 37.4% for laparoscopy. For both outcomes, the percentage of total variance attributable to surgeon factors was consistently higher than that attributable to patient characteristics.CONCLUSIONSFor many patients with kidney cancer, the surgery provided depends more on their surgeon's practice style than on the characteristics of the patient and his or her disease. Consequently, dismantling barriers to surgeon adoption of partial nephrectomy and laparoscopy is an important step toward improving the quality of care for patients with early‐stage kidney cancer. Cancer 2008. © 2008 American Cancer Society.

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Surgical Management of Renal Tumors 4 Cm. Or Less in a Contemporary Cohort

Abstract: Patients with a small renal tumor have similar perioperative morbidity, pathological stage and outcome regardless of treatment with partial or radical nephrectomy. Therefore, partial nephrectomy remains a safe alternative for tumors of this size.

Cited by 158 publications

References 34 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

Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study

Diffusion of surgical innovation among patients with kidney cancer

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