scholarly journals Oncological outcomes of partial nephrectomy for tumours larger than 4 cm: A systematic review

2014 ◽  
Vol 8 (1-2) ◽  
pp. 61 ◽  
Author(s):  
Tarek H El-Ghazaly ◽  
Ross J Mason ◽  
Ricardo A Rendon
Keyword(s):  
Systematic Review ◽  
Partial Nephrectomy ◽  
Survival Rates ◽  
Cancer Specific Survival ◽  
Renal Masses ◽  
Oncological Outcomes ◽  
Medical Associations ◽  
Nephron Sparing ◽  
Pubmed Search ◽  
Exact Size

Introduction: Many medical associations recommend nephron-sparing surgery (NSS) for tumours larger than 4 cm amenable to partial nephrectomy (PN). These recommendations are, however, mostly based on isolated reports. We systematically review the oncological outcomes of partial nephrectomy procedures performed for tumours larger than 4-cm.Methods: A PubMed search was carried out using keywords “partial nephrectomy” and “nephron sparing” for records dating back to 1995. In total, 2136 abstracts were analyzed; from these, 174 studies were scrutinized. We identified 32 manuscripts reporting size-specific cancer-specific survival rates for masses greater than 4 cm. From each of these studies, we recorded the number of PN, tumour diameter, follow-up duration, 5- and 10-year recurrence, overall and cancer-specific survival rates (OS, CSS). We also calculated weighted OS and CSS rates.Results: This systematic review includes 2445 patients with renal tumours larger than 4 cm who underwent PN: 1858 patients with tumours between 4 to 7 cm, 410 patients with tumours larger than 7 cm and 177 patients with tumours greater than 4 cm (exact size unknown). Our analysis revealed weighted 5-year CSS rates of 95.4%, 86.2% and 93.9% for tumours 4 to 7 cm, >7 cm, and all tumours >4 cm, respectively. The respective 5-year OS rates were 84.7%, 76.4%, and 84.7%.Conclusions: We found excellent 5-year CSS and OS rates for patients with tumours 4 to 7 cm treated with PN. These outcomes compare favourably to those reported in historical radical nephrectomy (RN) series for similarly sized tumours. Thus, PN is an acceptable and often preferred treatment for renal masses >4 cm which are amenable to nephron-sparing procedures.

scholarly journals Comparison of oncologic outcomes between partial nephrectomy and radical nephrectomy in patients who were upstaged from cT1 renal tumor to pT3a renal cell carcinoma: an updated systematic review and meta-analysis

2020 ◽  
Vol 12 ◽  
pp. 175628722098150
Author(s):  
Doo Yong Chung ◽  
Dong Hyuk Kang ◽  
Jong Won Kim ◽  
Do Kyung Kim ◽  
Joo Yong Lee ◽  
...  
Keyword(s):  
Systematic Review ◽  
Partial Nephrectomy ◽  
Renal Cell ◽  
Radical Nephrectomy ◽  
Large Scale ◽  
Meta Analysis ◽  
Oncologic Outcomes ◽  
Level Of Evidence ◽  
Cancer Specific Survival ◽  
Oncological Outcomes

Aim: Owing to the limited ability of current imaging modalities, several clinical T1 renal cell carcinomas (cT1 RCCa) can be pathologically upstaged to T3a (pT3a) after surgery. There have been some controversies regarding the oncological safety of partial nephrectomy (PNx) compared with radical nephrectomy (RNx) in these patients. We compared oncological outcomes of PNx and RNx in patients with upstaged pT3a RCCa. Methods: A systematic review was performed following the PRISMA guideline. PubMed, MEDLINE, Embase were searched. Oncological outcomes [recurrence-free survival (RFS), overall survival (OS) and cancer-specific survival (CSS)] between PNx and RNx were compared. The GRADE approach was used to rate the certainty of evidence. Results: A total of 7406 patients in 12 articles related to upstaged pT3a RCCa were included. In adjusted analysis, no difference was observed in RFS [hazard ratios (HR) 0.87; 95% confidence intervals (CI), 0.57–0.95; p = 0.88] and CSS (HR, 0.78; 95% CI, 0.59–1.04; p = 0.09) for PNx and RNx. Meanwhile, PNx was significantly associated with favorable OS compared with RNx (HR, 0.74; 95% CI, 0.57–0.95; p = 0.02). Conclusions: Our meta-analysis shows that patients treated with PNx have better or at least similar oncological outcomes compared with RNx in patients with upstaged pT3a RCCa from cT1. In particular, patients who had undergone PNx show a significantly improved OS. If PNx is available, we recommend performing PNx for all cT1 RCCa, even in patients with upstaging potential. However, due to the low level of evidence, large-scale randomized trials are required.

Functional and oncological outcomes of open nephron-sparing surgery for complex renal masses

2015 ◽  
Vol 33 (10) ◽  
pp. 427.e11-427.e16 ◽  
Author(s):  
Zaher Bahouth ◽  
Sarel Halachmi ◽  
Itamar Getzler ◽  
Orna Caspin ◽  
Boaz Moskovitz ◽  
...  
Keyword(s):  
Nephron Sparing Surgery ◽  
Renal Masses ◽  
Oncological Outcomes ◽  
Nephron Sparing

scholarly journals Efficacy of Partial Nephrectomy for Renal Tumors >4 cm: Comparison With Renal Tumors ≤4 cm

2016 ◽  
Vol 101 (1-2) ◽  
pp. 7-13
Author(s):  
Ohseong Kwon ◽  
Seok-Soo Byun ◽  
Sung Kyu Hong ◽  
Ja Hyeon Ku ◽  
Cheol Kwak ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Functional Outcomes ◽  
Survival Rates ◽  
Renal Tumors ◽  
Recurrence Free Survival ◽  
Renal Masses ◽  
Ischemic Time ◽  
Free Survival ◽  
Kaplan Meier ◽  
Computed Tomography Image

Partial nephrectomy has become a treatment of choice for clinical T1a renal masses. Some international guidelines suggest that partial nephrectomy can be applied also in clinical T1b tumors. The aim of this study was to evaluate the feasibility of partial nephrectomy for tumors larger than 4 cm. We reviewed the medical records of 1280 patients who underwent partial nephrectomy and had pathologically confirmed malignancy. Patients were categorized into two groups by the size of tumors on computed tomography image, with a cutoff value of 4 cm. The oncologic and functional outcomes were compared between the two groups. Recurrence-free survival after surgery was estimated using the Kaplan-Meier method. Of the 1280 patients, 203 patients (15.9%) had renal tumors larger than 4 cm. There were significantly more exophytic tumors (P < 0.001) and the R.E.N.A.L. scores were significantly higher (P < 0.001) in partial nephrectomy >4 cm. Mean ischemic times were significantly different (P < 0.001). After 24 months, mean creatinine level between partial nephrectomy >4 cm and partial nephrectomy ≤4 cm was not different significantly (P = 0.554). And the percent changes of glomerular filtration rate after partial nephrectomy were not different at last follow-up (P = 0.082). The 5-year recurrence-free survival rates were 96.6% in partial nephrectomy ≤4 cm, and 94.5% in partial nephrectomy >4 cm (P = 0.416). Based on the present findings, partial nephrectomy for tumors larger than 4 cm showed comparable feasibility and safety to partial nephrectomy for tumors ≤4 cm considering oncologic and functional outcomes, despite longer operative and ischemic time.

scholarly journals Intraoperative ultrasound in robot-assisted partial nephrectomy: State of the art

2018 ◽  
Vol 90 (3) ◽  
pp. 195-198 ◽  
Author(s):  
Giacomo Di Cosmo ◽  
Enrica Verzotti ◽  
Tommaso Silvestri ◽  
Andrea Lissiani ◽  
Roberto Knez ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
State Of The Art ◽  
Short Review ◽  
Robot Assisted ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Ischemia Time ◽  
Oncological Safety ◽  
Nephron Sparing ◽  
Operative Ultrasound

Introduction: Nephron-sparing surgery (NSS) is of one of the most studied fields in urology due to the balancing between renal function preservation and oncological safety of the procedure. Aim of this short review is to report the state of the art of intra-operative ultrasound as an operative tool to improve localization of small renal masses partially or completely endophytic during robotassisted partial nephrectomy (RAPN). Material and methods: We performed a literature review by electronic database on Pubmed about the use of intra-operative US in RAPN to evaluate the usefulness and the feasibility of this procedure. Results: Several studies analyzed the use of different US probes during RAPN. Among them some focused on using contrastenhanced ultra sonography (CEUS) for improving the dynamic evaluation of microvascular structure allowing the reduction of ischemia time (IT). We reported that nowaday the use of intraoperative US during RAPN could be helpful to improve the preservation of renal tissue without compromising oncological safety. Moreover, during RAPN there is no need for assistant to hand the US probe increasing surgeon autonomy. Conclusions: The use of a robotic ultrasound probe during partial nephrectomy allows the surgeon to optimize tumor identification with maximal autonomy, and to benefit from the precision and articulation of the robotic instrument during this key step of the partial nephrectomy procedure. Moreover US could be useful to reduce ischemia time (IT). The advantages of nephron-sparing surgery over radical nephrectomy is well established with a pool of data providing strong evidence of oncological and survival equivalency. With the progressive growth of robot-assisted partial nephrectomy (RAPN) techniques, the use of several tools has been progressively developed to help the surgeon in the identification of masses and its vascular net. In this short review we tried to analyze the current use of intra-operative ultrasound as an operative tool to improve localization of small renal masses partially or completely endophytic during RAPN.

scholarly journals Open Partial Nephrectomy in Renal Cancer: A Feasible Gold Standard Technique in All Hospitals

2008 ◽  
Vol 2008 ◽  
pp. 1-9 ◽  
Author(s):  
J. M. Cozar ◽  
M. Tallada
Keyword(s):  
Partial Nephrectomy ◽  
Gold Standard ◽  
Radical Nephrectomy ◽  
Young Patients ◽  
Standard Technique ◽  
Tumor Diameter ◽  
Cancer Specific Survival ◽  
Renal Masses ◽  
Open Partial Nephrectomy ◽  
Gold Standard Technique

Introduction. Partial nephrectomy (PN) is playing an increasingly important role in localized renal cell carcinoma (RCC) as a true alternative to radical nephrectomy. With the greater experience and expertise of surgical teams, it has become an alternative to radical nephrectomy in young patients when the tumor diameter is 4 cm or less in almost all hospitals since cancer-specific survival outcomes are similar to those obtained with radical nephrectomy.Materials and Methods. The authors comment on their own experience and review the literature, reporting current indications and outcomes including complications. The surgical technique of open partial nephrectomy is outlined.Conclusions. Nowadays, open PN is the gold standard technique to treat small renal masses, and all nonablative techniques must pass the test of time to be compared to PN. It is not ethical for patients to undergo radical surgery just because the urologists involved do not have adequate experience with PN. Patients should be involved in the final treatment decision and, when appropriate, referred to specialized centers with experience in open or laparoscopic partial nephrectomies.

Impact of relapse site on oncological outcomes after radical nephroureterectomy for upper urinary tract urothelial carcinoma.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 426-426
Author(s):  
Shinichi Yamashita ◽  
Akihiro Ito ◽  
Koji Mitsuzuka ◽  
Yoshihide Kawasaki ◽  
Ichiro Shintaku ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Local Recurrence ◽  
Lymph Nodes ◽  
Multivariate Analyses ◽  
Survival Rates ◽  
Upper Urinary Tract ◽  
Radical Nephroureterectomy ◽  
Cancer Specific Survival ◽  
Oncological Outcomes ◽  
The Impact

426 Background: Most upper urinary tract urothelial carcinomas (UTUC) are invasive and advanced with a poor prognosis. Patients often relapse after treatment with radical nephroureterectomy (RNU). However, little is known about an association between sites of recurrence after RNU and oncological outcomes. The present study retrospectively evaluated the impact of a first recurrence site on survival. Methods: A total of 650 patients with UTUC treated by RNU at 12 institutions that participated in the Tohoku Urological Evidence-Based Medicine Study Group between 2000 and 2011 were initially enrolled. Patients who experienced relapse other than intravesical recurrence after RNU were included in this study. Those who had metastasis at the time of UTUC diagnosis or missing data regarding the time and location of relapse were excluded. Finally, 173 patients were eligible to participate in this study. Survival rates were analyzed using Kaplan-Meier curves and the log-rank test, and factors predicting survival were assessed using multivariate analyses. Results: The median follow-up after relapse was nine months. The cancer-specific survival rates at one and two years after relapse were 49% and 22%, respectively. Cancer in 59 (34%), 32 (18%), 23 (13%), and 94 (53%) patients recurred in the lung, liver, bone and lymph nodes, and 23 (13%) had local recurrence. The one-year cancer-specific survival rates were 44%, 27%, 22% and 52% among patients with metastasis of the lungs, liver, bone and lymph nodes respectively, and 41% among those with local recurrence. The survival rate was worse among 48 patients with metastasis at multiple sites, than in those with metastasis at a single site. Fourteen (8%) patients with a single lymph, lung or local recurrence survived for over three years after a first relapse. Multivariate analyses selected the liver, bone and local recurrence as critical factors for cancer-specific survival. Conclusions: Liver or bone metastasis was a negative prognostic factor for UTUC with relapse after RNU. Information about recurrence sites might be helpful for patient counseling.

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