Nephron-Sparing Surgery in Renal Cell Carcinoma: Morbidity and Outcomes
Keywords:Kidney cancer, renal cell carcinoma, nephrectomy, treatment outcome, nephrons.
Objective: To present the partial nephrectomy series performed at our institution.
Patients and Methods: 147 patients underwent nephron-sparing surgery between Jan/2000 and Feb/2011. The mean patient age was 60.3 yrs (33.2-82.7), and 90 (61.2%) were men. The clinical presentation, pathological tumor features, perioperative complications, functional and oncological outcomes were analyzed.
Results: 84.4% of the renal masses were incidental, and the mean tumor size was 3,63 cm. Median warm ischemia time and estimated blood loss was 18 min (11-27) and 220 ml (50-480), respectively. Overall complication rate was 5%. 87.0% of the tumors were pT1, 5.7% were pT2, and 7.3% was pT3. 45 tumors were high-grade (30.6%), microvascular invasion was observed in eleven tumors (7.5%), presence of necrosis occurred in twenty-seven tumors (18.4%), and invasion of perirenal fat was identified in ten cases (6.8%). At a mean follow-up of 60 months, local recurrence was observed in only six cases (4.1%) and the cancer-specific survival in this series was 95.2%.
Conclusion: Open partial nephrectomy is safe and presented optimal oncological results. It should be used for treating small renal tumors whenever is technically feasible.
Nguyen MM, Gill IS, Ellison LM. The evolving presentation of renal carcinoma in the United States: trends from the Surveillance, Epidemiology, and End Results program. J Urol 2006; 176: 2397-400. http://dx.doi.org/10.1016/j.juro.2006.07.144
Kane CJ, Mallin K, Ritchey J, Cooperberg MR, Carroll PR. Renal cell cancer stage migration: analysis of the National Cancer Data Base. Cancer 2008; 113: 78-83. http://dx.doi.org/10.1002/cncr.23518
Belldegrun A, Tsui KH, deKernion JB, Smith RB. Efficacy of nephron-sparing surgery for renal cell carcinoma: analysis based on the new 1997 tumor-node-metastasis staging system. J Clin Oncol 1999; 17: 2868-75.
Licht MR, Novick AC. Nephron sparing surgery for renal cell carcinoma. J Urol 1993; 149: 1-7.
Herr HW. Partial nephrectomy for incidental renal cell carcinoma. Br J Urol 1994; 74: 431-3. http://dx.doi.org/10.1111/j.1464-410X.1994.tb00417.x
Filipas D, Fichtner J, Spix C, Black P, Carus W, Hohenfellner R, et al. Nephron-sparing surgery of renal cell carcinoma with a normal opposite kidney: long-term outcome in 180 patients. Urology 2000; 56: 387-92. http://dx.doi.org/10.1016/S0090-4295(00)00656-7
Weight CJ, Kaouk JH, Hegarty NJ, Remer EM, O'Malley CM, Lane BR, et al. Correlation of radiographic imaging and histopathology following cryoablation and radiofrequency ablation for renal tumors. J Urol 2008; 179: 1277-81. http://dx.doi.org/10.1016/j.juro.2007.11.075
Lerner SE, Hawkins CA, Blute ML, Grabner A, Wollan PC, Eickholt JT, et al. Disease outcome in patients with low stage renal cell carcinoma treated with nephron sparing or radical surgery. J Urol 1996; 155: 1868-73. http://dx.doi.org/10.1016/S0022-5347(01)66032-4
Patard JJ, Shvarts O, Lam JS, Pantuck AJ, Kim HL, Ficarra V, et al. Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience. J Urol 2004; 171: 2181-5. http://dx.doi.org/10.1097/01.ju.0000124846.37299.5e
Leibovich BC, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H. Nephron sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm results in outcome similar to radical nephrectomy. J Urol 2004; 171: 1066-70. http://dx.doi.org/10.1097/01.ju.0000113274.40885.db
Hafez KS, Fergany AF, Novick AC. Nephron sparing surgery for localized renal cell carcinoma: impact of tumor size on patient survival, tumor recurrence and TNM staging. J Urol 1999; 162: 1930-3. http://dx.doi.org/10.1016/S0022-5347(05)68071-8
Parkin CM, Whelan SL, Ferlay J, Teppo L, Thomas D. Cancer incidence in five Continents. Lyon, IARC Scientific Publications 2002; 8(155).
Brasil. Ministério da Saúde. Instituto Nacional de Câncer. Incidência de câncer no município de São Paulo, Brasil, 1983-88-93: tendência do período 1969-93.
Vasudevan A, Davies RJ, Shannon BA, Cohen RJ. Incidental renal tumours: the frequency of benign lesions and the role of preoperative core biopsy. BJU Int 2006; 97: 946-9. http://dx.doi.org/10.1111/j.1464-410X.2006.06126.x
Pasticier G, Timsit MO, Badet L, De La Torre Abril L, Halila M, Fassi Fehri H, et al. Nephron-sparing surgery for renal cell carcinoma: detailed analysis of complications over a 15-year period. Eur Urol 2006; 49: 485-90. http://dx.doi.org/10.1016/j.eururo.2005.12.049
Patard JJ, Pantuck AJ, Crepel M, Lam JS, Bellec L, Albouy B, et al. Morbidity and clinical outcome of nephron-sparing surgery in relation to tumour size and indication. Eur Urol 2007; 52: 148-54. http://dx.doi.org/10.1016/j.eururo.2007.01.039
Peycelon M, Hupertan V, Comperat E, Renard-Penna R, Vaessen C, Conort P, et al. Long-term outcomes after nephron sparing surgery for renal cell carcinoma larger than 4 cm. J Urol 2009; 181: 35-41. http://dx.doi.org/10.1016/j.juro.2008.09.025
Gill IS, Kavoussi LR, Lane BR, Blute ML, Babineau D, Colombo JR Jr, et al. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 2007; 178: 41-6. http://dx.doi.org/10.1016/j.juro.2007.03.038
Gill IS, Matin SF, Desai MM, Kaouk JH, Steinberg A, Mascha E, et al. Comparative analysis of laparoscopic versus open partial nephrectomy for renal tumors in 200 patients. J Urol 2003; 170: 64-8. http://dx.doi.org/10.1097/01.ju.0000072272.02322.ff
Lau WK, Blute ML, Weaver AL, Torres VE, Zincke H. Matched comparison of radical nephrectomy vs nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin Proc 2000; 75: 1236-42. http://dx.doi.org/10.4065/75.12.1236
Aboumarzouk OM, Stein RJ, Eyraud R, Haber GP, Chlosta PL, Somani BK, et al. Robotic versus laparoscopic partial nephrectomy: a systematic review and meta-analysis. Eur Urol 2012; 62: 1023-33. http://dx.doi.org/10.1016/j.eururo.2012.06.038
Simhan J, Smaldone MC, Tsai KJ, Li T, Reyes JM, Canter D, et al. Perioperative outcomes of robotic and open partial nephrectomy for moderately and highly complex renal lesions. J Urol 2012; 187: 2000-4. http://dx.doi.org/10.1016/j.juro.2012.01.064