The impact of delaying radical nephrectomy for stage II or higher renal cell carcinoma

Kim, Kwang Hyun; You, Dalsan; Jeong, In Gab; Song, Cheryn; Hong, Jun Hyuk; Ahn, Hanjong; Kim, Choung Soo

doi:10.1007/s00432-012-1230-2

Cited by 15 publications

(25 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[3] Among patients with RCC, shorter SWT was associated with larger tumor size, higher tumor stage and grade, and symptomatic presentation,[7–9] similar to our results. Also, we found an association between longer SWT and older age, non-white race, and higher ASA and CCI scores.…”

Section: Discussionsupporting

confidence: 85%

“…SWT was not associated with pathological upstaging, recurrence-free survival or CSS, even when performing subgroup analysis according to the TNM stage and the presence or absence of symptoms prior to the operation. [9] In the current study which included patients with SWT >3 months and tumors >4cm, no significant association was found between SWT and oncologic outcomes. However, consistent with previous studies, disease characteristics indicative of tumor aggressiveness, including tumor size and histology, were significantly associated with both SWT and outcome.…”

Section: Discussionmentioning

confidence: 58%

“…The cut-point of 3 months for SWT was chosen because prior surgical delay research has studied patients with SWT ≤3 months. [7–9] Later cut-points were not evaluated due to a limited number of patients with longer SWT. Restricted cubic splines with knots at the tertiles were used to test for non-linearity in SWT.…”

Section: Methodsmentioning

confidence: 99%

“…[7–9] These reports did not find a significant difference in the oncologic outcomes; however, small renal masses which may have been suitable for active surveillance, were included in two studies,[7, 8] while the third reported SWT <3 months from diagnosis. [9] Furthermore, the statistical methods used in these reports did not account for the time-dependent nature of SWT.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The effect of delaying nephrectomy on oncologic outcomes in patients with renal tumors greater than 4cm

Mano

Vertosick

Hakimi

et al. 2016

Urologic Oncology: Seminars and Original Investigations

View full text Add to dashboard Cite

Objectives Delaying nephrectomy <3 months does not adversely affect treatment outcome of renal tumors. Whether surgical waiting time (SWT; time from diagnosis to surgery) >3 months affects treatment outcome for large renal masses has not been well studied. We aimed to evaluate if SWT is associated with treatment outcome of renal masses >4cm, and identify patients more likely to experience prolonged SWT. Materials and Methods Data from 1,484 patients undergoing radical or partial nephrectomy at a single institution for a non-metastatic renal mass >4cm between 1995–2013 were reviewed. Patients with benign tumors and incomplete preoperative data were excluded. The association between SWT and disease upstaging at the time of surgery and recurrence at 2 and 5 years was assessed using logistic regression. Cancer-specific survival (CSS) and overall survival (OS) were assessed with landmark survival analyses and multivariable Cox proportional hazards models. All analyses were adjusted for patient and tumor characteristics. Results Of the final cohort of 1,278 patients, 267 (21%) had SWT >3 months. Patients with larger, symptomatic tumors had shorter SWT. Median follow-up for survivors was 3.8 years (IQR 1.5–7.4). On multivariable analysis, SWT was not associated with disease upstaging, recurrence or CSS. Longer SWT was associated with decreased OS (HR=1.17, 95% CI, 1.08–1.27, p=0.0002). Gender and tumor size, histology, and presentation were associated with disease upstaging, recurrence and CSS. The most common cause for surgical delay >3 months was evaluation and treatment of comorbidities. Conclusion Patient and tumor characteristics, rather than SWT, were associated with disease upstaging, recurrence and CSS, and should guide the decision to delay surgery when treating non-metastatic renal tumors >4cm.

show abstract

Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 58%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The effect of delaying nephrectomy on oncologic outcomes in patients with renal tumors greater than 4cm

Mano

Vertosick

Hakimi

et al. 2016

Urologic Oncology: Seminars and Original Investigations

View full text Add to dashboard Cite

show abstract

“…Deze bevinding wordt echter niet ondersteund door de literatuur. Bij patiënten met een niercelcarcinoom van stadium II of hoger leidde de wachttijd na de diagnose (4 weken of 1-3 maanden) niet tot verschillen in pathologische stadiëring of recidiefvrije overleving [21].…”

Section: Discussieunclassified

Case report. Perioperatieve anticoagulantia voor de behandeling van een vena cava inferior tumor trombus bij patiënten met niercelcarcinoom

Leeuwen

Verhagen

2017

Tijdschr Urol

View full text Add to dashboard Cite

Samenvatting Een 71-jarige patiënt met een niertumor met uitbreiding in de vena cava inferior (VCI) werd één dag voor de geplande operatiedatum, met uitgebreide longembolieën opgenomen op de intensive care. Trombolyse is ternauwernood succesvol, maar hij wordt toch alsnog geopereerd op een later tijdstip. Naar schatting heeft 4-10 % van de patiënten met een nieuw gediagnosticeerd niercelcarcinoom een tumortrombus in de (VCI). Dit geeft een verhoogde kans op trombo-embolische complicaties. Naar de effectiviteit van perioperatieve anticoagulantia bij patiënten met een lokaal uitgebreid niercelcarcinoom is echter nog geen gerandomiseerd onderzoek verricht. Op basis van expert opinion zijn anticoagulantia (low molecular weight heparins (LMWH) therapeutisch gedoseerd) bij patiënten met een niercelcarcinoom met uitbreiding in de VCI geïn-diceerd vanaf het moment van diagnose tot en met drie tot zes maanden na operatieve behandeling. Op basis van een literatuuronderzoek wordt aanbevolen om bij patiënten met een niercelcarcinoom met uitbreiding in de VCI direct te starten met therapeutische antistolling. Abstract A 71-year-old patient was diagnosed with a renal cell carcinoma with extension in the IVC. Patient was admitted to the intensive care one day before his planned surgery because of massive pulmonary embolism. Trombolysis was eventually effective and later a radical nephrectomy was successfully performed. Inferior vena caval (IVC) tumor thrombus occurs in 4-10% of patients diagnosed with renal cell carcinoma. These patients have an increased risk of venous thromboembolism. There is no randomized trial investigating the role of anticoagulants in this patient group. Based on expert opinion it is advised to start Low Molecular Weight Heparins (LMWH), in a therapeutic dose, at time of diagnosis up to three to six months following surgery. Based on a literature search on this subject immediate treatment with therapeutic LMWH is recommended in patients with a renal cell carcinoma extending in the IVC. Keywords renal cell carcinoma · tumor thrombus · pulmonary embolism · anticoagulants IntroductieHet niercelcarcinoom is de meest voorkomende maligne niertumor. In 2016 werden naar schatting 2.300 patiën-ten gediagnosticeerd met niercelcarcinoom. Naar schatting 980 patiënten overleden in dat jaar aan de gevolgen van niercelcarcinoom. Niercelcarcinomen vormen 2 % van alle oncologische tumoren en 90 % van de maligne niertumoren, waarbij het heldercellig niercelcarcinoom (60-70 %) en het papillaire niercelcarcinoom (15-30 %) het meest frequent

show abstract

Delayed surgery for localised and metastatic renal cell carcinoma: a systematic review and meta-analysis for the COVID-19 pandemic

et al. 2021

View full text Add to dashboard Cite

Purpose The COVID-19 pandemic has led to the cancellation or deferment of many elective cancer surgeries. We performed a systematic review on the oncological effects of delayed surgery for patients with localised or metastatic renal cell carcinoma (RCC) in the targeted therapy (TT) era. Method The protocol of this review is registered on PROSPERO(CRD42020190882). A comprehensive literature search was performed on Medline, Embase and Cochrane CENTRAL using MeSH terms and keywords for randomised controlled trials and observational studies on the topic. Risks of biases were assessed using the Cochrane RoB tool and the Newcastle-Ottawa Scale. For localised RCC, immediate surgery [including partial nephrectomy (PN) and radical nephrectomy (RN)] and delayed surgery [including active surveillance (AS) and delayed intervention (DI)] were compared. For metastatic RCC, upfront versus deferred cytoreductive nephrectomy (CN) were compared. Results Eleven studies were included for quantitative analysis. Delayed surgery was significantly associated with worse cancer-specific survival (HR 1.67, 95% CI 1.23-2.27, p < 0.01) in T1a RCC, but no significant difference was noted for overall survival. For localised ≥ T1b RCC, there were insufficient data for meta-analysis and the results from the individual reports were contradictory. For metastatic RCC, upfront TT followed by deferred CN was associated with better overall survival when compared to upfront CN followed by deferred TT (HR 0.61, 95% CI 0.43-0.86, p < 0.001). Conclusion Noting potential selection bias, there is insufficient evidence to support the notion that delayed surgery is safe in localised RCC. For metastatic RCC, upfront TT followed by deferred CN should be considered.

show abstract

The impact of delaying radical nephrectomy for stage II or higher renal cell carcinoma

Cited by 15 publications

References 24 publications

The effect of delaying nephrectomy on oncologic outcomes in patients with renal tumors greater than 4cm

The effect of delaying nephrectomy on oncologic outcomes in patients with renal tumors greater than 4cm

Case report. Perioperatieve anticoagulantia voor de behandeling van een vena cava inferior tumor trombus bij patiënten met niercelcarcinoom

Delayed surgery for localised and metastatic renal cell carcinoma: a systematic review and meta-analysis for the COVID-19 pandemic

Contact Info

Product

Resources

About