Elective nephron sparing surgery for renal cell carcinoma larger than 4 cm.
نویسندگان
چکیده
PURPOSE Elective nephron sparing surgery is established as an alternative to radical nephrectomy for renal cell carcinoma if tumors are small (4 cm or less, stage T1a). We compared outcomes in patients with renal cell carcinoma 4 cm or less (small) vs more than 4 cm (large) who were treated with nephron sparing surgery. MATERIALS AND METHODS Between 1979 and 2006, 618 patients underwent elective nephron sparing surgery at our institution. Of these patients 474 (76.7%) had renal cell carcinoma, which was 4 cm or less in 372 (78.5%) and more than 4 cm in 102 (21.5%). Followup was 4.7 (range 0.1 to 23.9) years for small and 4.7 (range 0.1 to 24.1) years for large tumors. Cancer specific survival and local recurrence free survival were estimated. RESULTS The estimated cancer specific survival rate at 5 years was 97.9% and 95.8%, and at 10 years it was 94.9% and 95.8% for small and large tumors, respectively (log rank p = 0.583). The survival rate free of local recurrence at 5 years was 98.5% and 98.3%, and at 10 years it was 93.9% and 98.3% for small and large tumors, respectively (log rank p = 0.282). In contrast to tumor size, stage 3 was associated with a significant higher risk of tumor related death. CONCLUSIONS Elective nephron sparing surgery is oncologically safe in select patients with localized renal cell carcinoma more than 4 cm. In our series the selection criterion for choosing elective nephron sparing surgery rather than radical nephrectomy over the years has consistently been safe surgical resectability rather than tumor size. However, there is a correlation between tumor size and unfavorable pathological tumor characteristics, which prompts caution when choosing elective nephron sparing surgery for all large tumors.
منابع مشابه
The Role of Nephron-Sparing Surgery (NSS) for Renal Tumours >4 cm
For many years, radical nephrectomy (RN) has been the gold standard treatment for renal tumours. However, at present the available evidence supports elective nephron-sparing surgery (NSS) as the standard surgical treatment for renal cortical tumours ≤4 cm (clinical stage T1a). Furthermore, an increasing body of evidence demonstrates that even a minor loss of renal function can increase cardiova...
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Nephron-sparing surgery (NSS) is a treatment of choice for renal cell carcinoma (RCC) less than 4 cm. in size. However its efficacy in the treatment of RCC from 4cm to 7 cm is not well defined and is still controversial. We retrospectively reviewed the records of 57 patients who underwent NSS at our institution for RCC of 4-7 cm in size, from 1994 to 2011. NSS was done by means of enucleoresec...
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ورودعنوان ژورنال:
- The Journal of urology
دوره 179 1 شماره
صفحات -
تاریخ انتشار 2008