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Published in: Annals of Surgical Oncology 4/2011

01-04-2011 | Urologic Oncology

Impact of Elective Versus Imperative Indications on Oncologic Outcomes After Open Nephron-Sparing Surgery for the Treatment of Sporadic Renal Cell Carcinomas

Authors: Grégoire Coffin, MD, Vincent Hupertan, MD, Lionel Taksin, MD, Christophe Vaessen, MD, Emmanuel Chartier-Kastler, MD, PhD, Marc-Olivier Bitker, MD, PhD, Morgan Rouprêt, MD, PhD

Published in: Annals of Surgical Oncology | Issue 4/2011

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Abstract

Purpose

To determine the effect of nephron-sparing surgery (NSS) on cancer control in renal cell carcinomas (RCC) and to compare the outcomes of patients who had elective versus imperative indications for surgery.

Methods

We performed a retrospective review of the data for patients treated with open NSS between 1980 and 2005 for sporadic RCCs. The following data were analyzed: age, intraoperative parameters, tumor size, Fuhrman grade, tumor, node, metastasis system disease stage, pathological data, and outcome.

Results

A total of 155 patients with a median age of 60 years were included. The mean preoperative and postoperative creatinine levels were 1.1 ± 0.3 mg/dl (range 0.6–2.6 mg/dl) and 1.2 ± 0.4 mg/dl (range 0.5–3.4 mg/dl), respectively. The mean tumor size was 3.8 ± 2 cm (range 1–10 cm). Margin status was positive in 15 cases (9.70%), and multifocal RCCs were observed in 36 patients (23.2%). Overall, NSS indications were elective in 96 cases (61.9%) and imperative in 59 cases (38.1%). Univariate analysis found that elective cases were associated with better perioperative outcomes (P = 0.01). In univariate analysis, tumor, node, metastasis system disease stage, multifocality, and indication were associated with recurrence (P < 0.05). In the multivariate analysis, only multifocality status and imperatives indications were significant (P < 0.05). The mean follow-up was 118.2 ± 151 months. The 5- and 10-year tumor-free survival rates were 81.8% and 78.7% in elective and imperatives cases, respectively.

Conclusions

Oncologic control seems to be better for cases of elective open NSS. Thus, NSS should be advocated as soon as it is technically possible, regardless of the size of the tumor.
Literature
1.
2.
go back to reference Antonelli A, Cozzoli A, Nicolai M, et al. Nephron-sparing surgery versus radical nephrectomy in the treatment of intracapsular renal cell carcinoma up to 7 cm. Eur Urol. 2008;53:803–9.PubMedCrossRef Antonelli A, Cozzoli A, Nicolai M, et al. Nephron-sparing surgery versus radical nephrectomy in the treatment of intracapsular renal cell carcinoma up to 7 cm. Eur Urol. 2008;53:803–9.PubMedCrossRef
3.
go back to reference Ljungberg B, Hanbury DC, Kuczyk MA, et al. Renal cell carcinoma guideline. Eur Urol. 2007;51:1502–10.PubMedCrossRef Ljungberg B, Hanbury DC, Kuczyk MA, et al. Renal cell carcinoma guideline. Eur Urol. 2007;51:1502–10.PubMedCrossRef
4.
go back to reference Mejean A, Hopirtean V, Bazin JP, et al. Prognostic factors for the survival of patients with papillary renal cell carcinoma: meaning of histological typing and multifocality. J Urol. 2003;170:764–7.PubMedCrossRef Mejean A, Hopirtean V, Bazin JP, et al. Prognostic factors for the survival of patients with papillary renal cell carcinoma: meaning of histological typing and multifocality. J Urol. 2003;170:764–7.PubMedCrossRef
5.
go back to reference Lau WK, Blute ML, Weaver AL, et al. 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.PubMedCrossRef Lau WK, Blute ML, Weaver AL, et al. 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.PubMedCrossRef
6.
go back to reference Mitchell RE, Gilbert SM, Murphy AM, et al. Partial nephrectomy and radical nephrectomy offer similar cancer outcomes in renal cortical tumors 4 cm or larger. Urology. 2006;67:260–4.PubMedCrossRef Mitchell RE, Gilbert SM, Murphy AM, et al. Partial nephrectomy and radical nephrectomy offer similar cancer outcomes in renal cortical tumors 4 cm or larger. Urology. 2006;67:260–4.PubMedCrossRef
7.
go back to reference Pasticier G, Timsit MO, Badet L, et al. Nephron-sparing surgery for renal cell carcinoma: detailed analysis of complications over a 15-year period. Eur Urol. 2006;49:485–90.PubMedCrossRef Pasticier G, Timsit MO, Badet L, et al. Nephron-sparing surgery for renal cell carcinoma: detailed analysis of complications over a 15-year period. Eur Urol. 2006;49:485–90.PubMedCrossRef
8.
go back to reference Huang WC, Levey AS, Serio AM, et al. Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol. 2006;7:735–40.PubMedCrossRef Huang WC, Levey AS, Serio AM, et al. Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol. 2006;7:735–40.PubMedCrossRef
9.
go back to reference Lee CT, Katz J, Shi W, et al. Surgical management of renal tumors 4 cm. or less in a contemporary cohort. J Urol. 2000;163:730–6.PubMedCrossRef Lee CT, Katz J, Shi W, et al. Surgical management of renal tumors 4 cm. or less in a contemporary cohort. J Urol. 2000;163:730–6.PubMedCrossRef
10.
go back to reference Novick AC, Streem S, Montie JE, et al. Conservative surgery for renal cell carcinoma: a single-center experience with 100 patients. 1989. J Urol. 2002;167:878–83. Novick AC, Streem S, Montie JE, et al. Conservative surgery for renal cell carcinoma: a single-center experience with 100 patients. 1989. J Urol. 2002;167:878–83.
11.
go back to reference Pahernik S, Roos F, Hampel C, et al. Nephron sparing surgery for renal cell carcinoma with normal contralateral kidney:25 years of experience. J Urol. 2006;175:2027–31.PubMedCrossRef Pahernik S, Roos F, Hampel C, et al. Nephron sparing surgery for renal cell carcinoma with normal contralateral kidney:25 years of experience. J Urol. 2006;175:2027–31.PubMedCrossRef
12.
go back to reference Ghavamian R, Cheville JC, Lohse CM, et al. Renal cell carcinoma in the solitary kidney: an analysis of complications and outcome after nephron sparing surgery. J Urol. 2002;168:454–9.PubMedCrossRef Ghavamian R, Cheville JC, Lohse CM, et al. Renal cell carcinoma in the solitary kidney: an analysis of complications and outcome after nephron sparing surgery. J Urol. 2002;168:454–9.PubMedCrossRef
13.
go back to reference Dash A, Vickers AJ, Schachter LR, et al. Comparison of outcomes in elective partial vs radical nephrectomy for clear cell renal cell carcinoma of 4–7 cm. BJU Int. 2006;97:939–45.PubMedCrossRef Dash A, Vickers AJ, Schachter LR, et al. Comparison of outcomes in elective partial vs radical nephrectomy for clear cell renal cell carcinoma of 4–7 cm. BJU Int. 2006;97:939–45.PubMedCrossRef
14.
go back to reference Denzinger S, Ganzer R, Fink A, et al. Open partial nephrectomy for imperative and elective indications comparison of peri-operative data and long-term follow-up. Scand J Urol Nephrol. 2007;41:496–500.PubMedCrossRef Denzinger S, Ganzer R, Fink A, et al. Open partial nephrectomy for imperative and elective indications comparison of peri-operative data and long-term follow-up. Scand J Urol Nephrol. 2007;41:496–500.PubMedCrossRef
15.
go back to reference Haferkamp A, Kurosch M, Pritsch M, et al. Prognostic factors influencing long-term survival of patients undergoing nephron-sparing surgery for nonmetastatic renal-cell carcinoma (RCC) with imperative indications. Ann Surg Oncol. 2010;17:544–51.PubMedCrossRef Haferkamp A, Kurosch M, Pritsch M, et al. Prognostic factors influencing long-term survival of patients undergoing nephron-sparing surgery for nonmetastatic renal-cell carcinoma (RCC) with imperative indications. Ann Surg Oncol. 2010;17:544–51.PubMedCrossRef
16.
go back to reference Kural AR, Demirkesen O, Onal B, et al. Outcome of nephron-sparing surgery: elective versus imperative indications. Urol Int. 2003;71:190–6.PubMedCrossRef Kural AR, Demirkesen O, Onal B, et al. Outcome of nephron-sparing surgery: elective versus imperative indications. Urol Int. 2003;71:190–6.PubMedCrossRef
17.
go back to reference Sobin L, Gospodarowicz M, Wittekind C. TNM classification of malignant tumours. Urological tumours. 7th rev. New York: Wiley-Blackwell/UICC, 2009; p. 237–66. Sobin L, Gospodarowicz M, Wittekind C. TNM classification of malignant tumours. Urological tumours. 7th rev. New York: Wiley-Blackwell/UICC, 2009; p. 237–66.
18.
go back to reference Roupret M, Hopirtean V, Mejean A, et al. Nephron sparing surgery for renal cell carcinoma and von Hippel-Lindau’s disease: a single center experience. J Urol. 2003;170:1752–5.PubMedCrossRef Roupret M, Hopirtean V, Mejean A, et al. Nephron sparing surgery for renal cell carcinoma and von Hippel-Lindau’s disease: a single center experience. J Urol. 2003;170:1752–5.PubMedCrossRef
19.
go back to reference Peycelon M, Hupertan V, Comperat E, et al. Long-term outcomes after nephron sparing surgery for renal cell carcinoma larger than 4 cm. J Urol. 2009;181:35–41.PubMedCrossRef Peycelon M, Hupertan V, Comperat E, et al. Long-term outcomes after nephron sparing surgery for renal cell carcinoma larger than 4 cm. J Urol. 2009;181:35–41.PubMedCrossRef
20.
go back to reference Patard JJ, Pantuck AJ, Crepel M, et al. Morbidity and clinical outcome of nephron-sparing surgery in relation to tumour size and indication. Eur Urol. 2007;52:148–54.PubMedCrossRef Patard JJ, Pantuck AJ, Crepel M, et al. Morbidity and clinical outcome of nephron-sparing surgery in relation to tumour size and indication. Eur Urol. 2007;52:148–54.PubMedCrossRef
21.
go back to reference Patard JJ, Shvarts O, Lam JS, et al. Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience. J Urol. 2004;171:2181–5.PubMedCrossRef Patard JJ, Shvarts O, Lam JS, et al. Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience. J Urol. 2004;171:2181–5.PubMedCrossRef
22.
go back to reference Bensalah K, Crepel M, Patard JJ, Tumor size and nephron-sparing surgery: does it still matter? Eur Urol. 2008;53:691–3.PubMedCrossRef Bensalah K, Crepel M, Patard JJ, Tumor size and nephron-sparing surgery: does it still matter? Eur Urol. 2008;53:691–3.PubMedCrossRef
23.
go back to reference Sutherland SE, Resnick MI, Maclennan GT, et al. Does the size of the surgical margin in partial nephrectomy for renal cell cancer really matter? J Urol. 2002;167:61–4.PubMedCrossRef Sutherland SE, Resnick MI, Maclennan GT, et al. Does the size of the surgical margin in partial nephrectomy for renal cell cancer really matter? J Urol. 2002;167:61–4.PubMedCrossRef
24.
go back to reference McKiernan J, Simmons R, Katz J, et al. Natural history of chronic renal insufficiency after partial and radical nephrectomy. Urology. 2002;59:816–20.PubMedCrossRef McKiernan J, Simmons R, Katz J, et al. Natural history of chronic renal insufficiency after partial and radical nephrectomy. Urology. 2002;59:816–20.PubMedCrossRef
25.
go back to reference Bensalah K, Pantuck AJ, Rioux-Leclercq N, et al. Positive surgical margin appears to have negligible impact on survival of renal cell carcinomas treated by nephron-sparing surgery. Eur Urol. 2010;57:466–71.PubMedCrossRef Bensalah K, Pantuck AJ, Rioux-Leclercq N, et al. Positive surgical margin appears to have negligible impact on survival of renal cell carcinomas treated by nephron-sparing surgery. Eur Urol. 2010;57:466–71.PubMedCrossRef
26.
go back to reference Raz O, Mendlovic S, Shilo Y, et al. Positive surgical margins with renal cell carcinoma have a limited influence on long-term oncological outcomes of nephron sparing surgery. Urology. 2010;75:277–80.PubMedCrossRef Raz O, Mendlovic S, Shilo Y, et al. Positive surgical margins with renal cell carcinoma have a limited influence on long-term oncological outcomes of nephron sparing surgery. Urology. 2010;75:277–80.PubMedCrossRef
27.
go back to reference Song C, Bang JK, Park HK, et al. Factors influencing renal function reduction after partial nephrectomy. J Urol. 2009;181:48–54.PubMedCrossRef Song C, Bang JK, Park HK, et al. Factors influencing renal function reduction after partial nephrectomy. J Urol. 2009;181:48–54.PubMedCrossRef
28.
go back to reference Timsit MO, Bazin JP, Thiounn N, et al. Prospective study of safety margins in partial nephrectomy: intraoperative assessment and contribution of frozen section analysis. Urology. 2006;67:923–6.PubMedCrossRef Timsit MO, Bazin JP, Thiounn N, et al. Prospective study of safety margins in partial nephrectomy: intraoperative assessment and contribution of frozen section analysis. Urology. 2006;67:923–6.PubMedCrossRef
29.
go back to reference Neuzillet Y, Long JA, Paparel P, et al. Clamping modalities during partial nephrectomy: technical aspects and functional consequences. Review by the Comite de cancerologie de l’Association francaise d’urologie (CCAFU). Prog Urol. 2009;19:524–9.PubMedCrossRef Neuzillet Y, Long JA, Paparel P, et al. Clamping modalities during partial nephrectomy: technical aspects and functional consequences. Review by the Comite de cancerologie de l’Association francaise d’urologie (CCAFU). Prog Urol. 2009;19:524–9.PubMedCrossRef
30.
go back to reference Lida S, Kondo T, Amano H, et al. Minimal effect of cold ischemia time on progression to late-stage chronic kidney disease observed long term after partial nephrectomy. Urology. 2008;72:1083–9.CrossRef Lida S, Kondo T, Amano H, et al. Minimal effect of cold ischemia time on progression to late-stage chronic kidney disease observed long term after partial nephrectomy. Urology. 2008;72:1083–9.CrossRef
31.
go back to reference Joniau S, Vander Eeckt K, Srirangam SJ, et al. Outcome of nephron-sparing surgery for T1b renal cell carcinoma. BJU Int. 2009;103:1344–8.PubMedCrossRef Joniau S, Vander Eeckt K, Srirangam SJ, et al. Outcome of nephron-sparing surgery for T1b renal cell carcinoma. BJU Int. 2009;103:1344–8.PubMedCrossRef
32.
go back to reference Funahashi Y, Hattori R, Yamamoto T, et al. Ischemic renal damage after nephron-sparing surgery in patients with normal contralateral kidney. Eur Urol. 2009;55:209–15.PubMedCrossRef Funahashi Y, Hattori R, Yamamoto T, et al. Ischemic renal damage after nephron-sparing surgery in patients with normal contralateral kidney. Eur Urol. 2009;55:209–15.PubMedCrossRef
33.
go back to reference Rouach Y, Delongchamps NB, Patey N, et al. Suture or hemostatic agent during laparoscopic partial nephrectomy? A randomized study using a hypertensive porcine model. Urology. 2009;73:172–7.PubMedCrossRef Rouach Y, Delongchamps NB, Patey N, et al. Suture or hemostatic agent during laparoscopic partial nephrectomy? A randomized study using a hypertensive porcine model. Urology. 2009;73:172–7.PubMedCrossRef
34.
go back to reference Benway BM, Bhayani SB, Rogers CG, et al. Robot-assisted partial nephrectomy: an international experience. Eur Urol. 2010;57:815–20.PubMedCrossRef Benway BM, Bhayani SB, Rogers CG, et al. Robot-assisted partial nephrectomy: an international experience. Eur Urol. 2010;57:815–20.PubMedCrossRef
35.
go back to reference Gill IS, Colombo JR, Jr., Frank I, et al. Laparoscopic partial nephrectomy for hilar tumors. J Urol. 2005;174:850–4.PubMedCrossRef Gill IS, Colombo JR, Jr., Frank I, et al. Laparoscopic partial nephrectomy for hilar tumors. J Urol. 2005;174:850–4.PubMedCrossRef
Metadata
Title
Impact of Elective Versus Imperative Indications on Oncologic Outcomes After Open Nephron-Sparing Surgery for the Treatment of Sporadic Renal Cell Carcinomas
Authors
Grégoire Coffin, MD
Vincent Hupertan, MD
Lionel Taksin, MD
Christophe Vaessen, MD
Emmanuel Chartier-Kastler, MD, PhD
Marc-Olivier Bitker, MD, PhD
Morgan Rouprêt, MD, PhD
Publication date
01-04-2011
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 4/2011
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-010-1457-6

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