Partial Nephrectomy Is Associated with Improved Overall Survival Compared to Radical Nephrectomy in Patients with Unanticipated Benign Renal Tumours

Glickman Urologic and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue,Cleveland, OH 44195, USA.
European Urology (Impact Factor: 13.94). 08/2010; 58(2):293-8. DOI: 10.1016/j.eururo.2010.04.033
Source: PubMed


Partial nephrectomy (PN) has been associated with improved overall survival (OS) in select cohorts with localised renal masses when compared to radical nephrectomy (RN). The driving forces behind these differences have been difficult to elucidate given the heterogeneity of previously compared cohorts.
Compare OS in a subset of patients with unanticipated benign renal masses to minimise the confounding effect of cancer.
We retrospectively evaluated 2608 consecutive clinical T1 enhancing renal masses that were treated with extirpative surgery at our institution between 1999 and 2006. Of these, 499 tumours (19%) were found to be benign on final pathology. Preoperative data and renal functional data were used to generate a propensity model that was then plugged into a multivariate model of survival. Median follow-up for the entire cohort was 50 mo (interquartile range [IQR]: 32-73).
All patients underwent PN or RN.
We measured OS and cardiac-specific survival.
Five-year OS estimates for the PN (n=388) and RN (n=111) cohorts were 95% (95% confidence interval [CI], 93-98) versus 83% (95% CI, 74-90), respectively (P<0.0001). On multivariate analysis, controlling for both comorbidity and age, RN was associated with a 2.5-fold increased risk of death compared to PN (hazard ratio [HR]: 2.5; 95% CI, 1.3-5.1). Postoperative estimated glomerular filtration rate (eGFR) was also an independent predictor of OS and cardiac-specific survival (HR: 0.97; 95% CI, 0.95-0.99 and HR: 0.96; 95% CI, 0.93-0.99, respectively). The retrospective nature of this analysis limits the strength of the conclusions.
PN was associated with better OS when compared to RN in patients with unanticipated benign tumours. This observed survival advantage appears partly to be the result of better preservation of eGFR, but other kidney functions or unmeasured factors may also play a role. These data indicate that PN should be aggressively pursued in any patient where PN is technically feasible.

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    • "Radical nephrectomy was associated with worse overall and cardiovascular survival compared to partial nephrectomy in patients with localized renal cell carcinoma 2 cm or less. To minimise a potential confounding effect of cancer mortality on the interpretation of these epidemiological data, one study compared overall survival (OS) in a subset of patients with unanticipated benign SRM [9]. On retrospective multivariate cohort analysis, controlling for both comorbidity and age, radical nephrectomy was associated with a 2.5-fold increased risk of death compared to partial nephrectomy (95% CI, 1.3–5.1). "
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    ABSTRACT: With an increasing number of small renal masses being diagnosed organ-preserving treatment strategies such as nephron-sparing surgery (NSS) or radiofrequency and cryoablation are gaining importance. There is evidence that preserving renal function reduces the risk of death of any cause, cardiovascular events, and hospitalization. Some patients have unfavourable tumor locations or large tumors unsuitable for NSS or ablation which is a clinical problem especially in those with imperative indications to preserve renal function. These patients may benefit from downsizing primary tumors by targeted therapy. This paper provides an overview of the current evidence, safety, controversies, and ongoing trials.
    Full-text · Article · Jun 2012 · International Journal of Surgical Oncology
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    • "Multiple retrospective studies have shown no difference between PN and RN with regard to cancer-specific survival and rate to distant metastasis at long-term follow-up, but with greater renal function perseveration with PN [9–13]. Furthermore, several retrospective studies associate PN with better overall survival compared to RN [10, 14–17]. However, further investigation is still needed as the only prospective randomized trial comparing PN with RN showed an overall survival advantage for RN when using a intention-to-treat analysis [18]. "
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    ABSTRACT: Partial nephrectomy (PN) offers equivalent oncologic outcomes to radical nephrectomy (RN) but has greater preservation of renal function and less risk of chronic kidney disease and cardiovascular disease. Laparoscopic PN remains underutilized likely because it is a technically challenging operation with higher rates of perioperative complications compared to open PN and laparoscopic RN. A review of the latest PN literature demonstrates that recent advancements in laparoscopic approaches, imaging modalities, ischemic mitigating strategies, renorrhaphy techniques, and hemostatic agents will likely allow greater utilization of LPN and expand its usage to increasingly more complex tumors.
    Full-text · Article · May 2012 · Advances in Urology
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    • "In addition, there is increasing evidence supporting the use of NSS for higher-stage lesions, with improved overall survival and similar cancer-specific survival compared with RN [13] [14] [15]. The improved overall survival after NSS was also reported in patients with unanticipated benign renal tumours on final pathology [16]. The laparoscopic approach to NSS for localised RCC has been well documented [17] [18]. "
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    ABSTRACT: Background There has been an exponential growth in the reporting of series of robotic partial nephrectomy (RPN). We review the technique of RPN and the outcomes from large single-centre series of RPN.Methods We searched databases to identify original articles related to RPN. For the technical aspects, we describe our technique and provide a general review of previous work. For outcomes, we reviewed previous reports using more rigid criteria, including only single-institution studies with at least 50 patients undergoing RPN.ResultsWe found seven retrospective studies that met our criteria, with a total of 701 patients. Mean tumour size was 2.8 cm, with an average R.E.N.A.L. score (Radius, tumour size as maximum diameter; Exophytic/endophytic properties of the tumour, Nearness of tumour deepest portion to the collecting system or sinus, Anterior, a/posterior, p, descriptor, and the Location relative to the polar line) of 6.8. The mean warm ischaemia time was 21 min and mean operative duration was 196 min. The mean estimated blood loss was 182 mL, with a 7.4% transfusion rate. The conversion rate was 1.7% and the postoperative complication rate was 14%. The mean length of stay was 3.6 days. There were positive surgical margins in 1.7% of patients. The mean decrease in renal function was 5.4% and the mean follow-up was 8.4 months.ConclusionsRPN is feasible and safe for different levels of complexity of renal tumours. Perioperative outcomes are comparable to those found with more established techniques. Future studies should compare different approaches and prioritise prospective and randomised designs.
    Full-text · Article · Mar 2012 · Arab Journal of Urology
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