Faculty Collaboration Database

Oncological efficacy and safety of nephron-sparing surgery for selected patients with locally advanced renal cell carcinoma. BJU Int 2007 Dec;100(6):1235-9

Date

11/06/2007

Pubmed ID

17979923

DOI

10.1111/j.1464-410X.2007.07225.x

Scopus ID

2-s2.0-35748975128 (requires institutional sign-in at Scopus site)   53 Citations

Abstract

OBJECTIVE: To evaluate perioperative complication rates, recurrence-free and cancer-specific survival (CSS) in a large group of matched patients who had nephron-sparing surgery (NSS) or radical nephrectomy (RN) for pT2-T3bN0M0 renal cell carcinoma (RCC).

PATIENTS AND METHODS: With approval from the institutional review board, the institutional nephrectomy database of 3470 patients treated at the authors' institution from 1990 to 2006 was searched for patients who had NSS or RN for unilateral, sporadic, pathological T2-T3bN0M0 RCC. Patients with non-metastatic, node-negative RCC and a follow-up of >/=6 months were included in the analysis.

RESULTS: In all, 601 patients treated with RN (567) or NSS (34) for pT2-T3bN0M0 RCC and a mean (median, range) follow-up of 43.4 (31.8, 6.1-172.6) and 62.1 (37.5, 7.0-192.0) months, respectively, met the study inclusion criteria. Disease recurred in four of 34 (12%) patients treated with NSS and in 164/567 (28.9%) managed with RN at a median of 24.2 and 13.2 months, respectively. There were no local recurrences among patients treated with NSS. On multivariate Cox proportional-hazards regression analysis, when adjusted for the effects of stage, grade, size and tumour histology, procedure type (NSS vs RN) was not an independent predictor of disease recurrence or RCC-specific death. Patients treated with NSS had a higher procedure-related complication rate, but similar estimated intraoperative blood loss, transfusion rate, equal duration of surgical procedure and hospital stay compared with patients managed with RN.

CONCLUSION: In highly selected patients with locally advanced RCC, NSS is safe and provides oncological outcomes equivalent to patients managed with RN.

Author List

Margulis V, Tamboli P, Jacobsohn KM, Swanson DA, Wood CG

Author

Kenneth Jacobsohn MD Professor in the Urologic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Carcinoma, Renal Cell
Female
Follow-Up Studies
Humans
Kidney Neoplasms
Male
Middle Aged
Neoplasm Recurrence, Local
Nephrectomy
Nephrons
Postoperative Complications
Retrospective Studies
Survival Analysis
Treatment Outcome