Functional, oncological outcomes and safety of nephron-sparing surgery versus radical nephrectomy in patients with localised renal cell carcinoma with high anatomical complexity: a retrospective cohort study with propensity score matching method

BackgroundNephron-sparing surgery (NSS) is widely applied for small renal masses. However, the indication of NSS in patients with localised renal cell carcinoma (RCC) with high anatomical complexity is controversial. Thus, we compare functional and oncological outcomes, and safety of NSS versus radical nephrectomy (RN) in patients with localised RCC with high anatomical complexity Radius, Exophytic/endophytic, Nearness, Anterior/posterior, Location. (R.E.N.A.L.) score ≥10.MethodsWe evaluated 575 patients with localised RCC that underwent NSS or RN at our centre between January 2013 and December 2018. Demographic characteristics, comorbidities, tumour data, surgery procedure, perioperative data and survival data were recorded. After propensity score matching, the variables were compared by binary paired logistic regression. The change in estimated glomerular filtration rate (eGFR) was compared with covariance analysis adjusted for baseline value. Recurrence and survival were calculated using Kaplan-Meier curves with log-rank tests. P<0.05 was considered to be statistically significant.ResultsIn the matched group, NSS showed lower eGFR loss compared with the RN group (17.81 mL/min/1.73 m2 vs 28.28 mL/min/1.73 m2, p<0.001). Moreover, the recurrence-free survival (p=0.002), cardiocerebrovascular disease-specific survival (p=0.015) and overall survival (p=0.017) of patients with NSS were better than those that underwent RN. Cancer-specific survival in both groups showed no difference (p=0.323). The incidence of minor and major complications in the two groups showed no difference (p=0.144, p=0.108).ConclusionNSS resulted in better preservation of renal function and oncological outcomes compared with RN, with acceptable complications. These findings could help improve clinical decision making for patients with localised RCC with high anatomical complexity.Trial registration numberChiCTR2000040652.

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Faculty Opinions recommendation of A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.8848956.9392054 ◽

2011 ◽

Author(s):

Alessandro Volpe

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Radical Nephrectomy ◽

Oncologic Outcome ◽

Nephron Sparing Surgery ◽

Phase 3 ◽

Nephron Sparing

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Re: Hendrik Van Poppel, Luigi Da Pozzo, Walter Albrecht, et al. A Prospective, Randomised EORTC Intergroup Phase 3 Study Comparing the Oncologic Outcome of Elective Nephron-Sparing Surgery and Radical Nephrectomy for Low-Stage Renal Cell Carcinoma. Eur Urol 2011;59:543–52

European Urology ◽

10.1016/j.eururo.2011.05.009 ◽

2011 ◽

Vol 60 (2) ◽

pp. e9 ◽

Cited By ~ 3

Author(s):

Raguram Ganesamoni ◽

Ravimohan Mavuduru ◽

Mayank Mohan Agarwal

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Radical Nephrectomy ◽

Oncologic Outcome ◽

Nephron Sparing Surgery ◽

Phase 3 ◽

Nephron Sparing

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Comparison of Long-Term Results After Nephron-Sparing Surgery and Radical Nephrectomy in Treating 4- to 7-cm Renal Cell Carcinoma

Medicina ◽

10.3390/medicina49050036 ◽

2013 ◽

Vol 49 (5) ◽

pp. 36 ◽

Cited By ~ 3

Author(s):

Daimantas Milonas ◽

Giedrius Skulčius ◽

Ruslanas Baltrimavičius ◽

Stasys Auškalnis ◽

Marius Kinčius ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Radical Nephrectomy ◽

Nephron Sparing Surgery ◽

Rank Test ◽

Cancer Specific Survival ◽

Log Rank Test ◽

Nephron Sparing

Objective. The aim of our study was to compare long-term oncological outcomes following nephron-sparing surgery (NSS) and radical nephrectomy (RN) for renal cell carcinoma (RCC) 4 to 7 cm in diameter. Material and Methods. The study included patients who underwent RN or NSS for RCC 4 to 7 cm in diameter between 1998 and 2009. The studied groups were compared with respect to the patients’ age, sex, physical status according to the American Society of Anesthesiologists Physical classification, histological type, stage, tumor size, grade, duration of the operation, and complications. Survival was established using the Kaplan-Meier method. The risk factors for survival were analyzed using a multivariate Cox regression model. Results. During the study, 351 patients underwent surgery: 317 patients (90.3%) underwent RN, and 34 (9.7%), NSS. The compared groups differed with respect to tumor size (P=0.001) and stage (P=0.006). The overall estimated 12-year survival was 53.7% after RN and 55.2% after NSS (log-rank test P=0.437). The 12-year cancer-specific survival in the RN and NSS groups was 69.6% and 80.6%, respectively (log-rank test P=0.198). Pathological stage and patients’ age were the major factors affecting both overall and cancer-specific survival. The type of surgery (NSS or RN) had no effect on survival. Conclusions. Our study showed that nephron-sparing surgery is a safe technique compared with radical nephrectomy that ensures good oncological control in the treatment of renal cell carcinoma measuring 4 to 7 cm and may be proposed as the treatment of choice for renal tumors not only up to 4 cm, but also 4 to 7 cm in size.

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