Mini-Margin Nephron Sparing Surgery for Renal Cell Carcinoma 4 cm or Less

Objectives. To explore the safety and efficacy of mini-margin nephron sparing surgery (NSS) for renal cell carcinoma (RCC) 4 cm or less.Methods. Total of 389 cases of RCC 4 cm or less with normal contralateral kidneys were included in the study, including 135 cases treated by mini-margin NSS, 98 by 1 cm-NSS and 156 by radical nephrectomy (RN). The clinical results were followed-up and comparatively analyzed.Results. The mean and median margin width for mm-NSS was 2.2 and 2.0 mm (range 0 to 5). Of them, 112 (83.0%) cases had margins of 3 mm or less, and 26 had margins of 0 mm (19.3%). The mean width of margin for 1 cm-NSS was 11.6 mm (median 12, range 10~15). None of the NSS patients had positive surgical margins. The mean follow-up for mm-NSS, 1 cm-NSS and RN patients was 69, 82 and 82 months, respectively. Three mm-NSS patients, two 1 cm- NSS and four RN patients died of non-cancer related causes. Two mm-NSS patient (1.6%) experienced local recurrence. No distant metastasis was detected in all the patients. The over all 5-year survivals for NSS and RN patients were 100%, 100% and 98.7%, respectively (P=.950).Conclusions. Mini-margin NSS is as safe and effective as 1 cm-NSS and RN in treating early localized RCC 4 cm or less.

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Nephron sparing surgery in von Hippel-Lindau associated renal cell carcinoma; clinicopathological long-term follow-up

Familial Cancer ◽

10.1007/s10689-012-9525-7 ◽

2012 ◽

Vol 11 (3) ◽

pp. 387-394 ◽

Cited By ~ 9

Author(s):

C. A. Jilg ◽

Hartmut P. H. Neumann ◽

S. Gläsker ◽

O. Schäfer ◽

C. Leiber ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Nephron Sparing Surgery ◽

Von Hippel Lindau ◽

Nephron Sparing ◽

Long Term Follow Up

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MP50-02 IS FOLLOW UP BEYOND 2 YEARS NECESSARY FOR PT1A RENAL CELL CARCINOMA TREATED WITH NEPHRON SPARING SURGERY? AN ASSESSMENT OF LATE RECURRENCES AND SURVEILLANCE COSTS.

The Journal of Urology ◽

10.1016/j.juro.2015.02.1667 ◽

2015 ◽

Vol 193 (4S) ◽

Author(s):

Kamran Zargar-Shoshtari ◽

Tim Kim ◽

Ross Simon ◽

Pranav Sharma ◽

Binglin Yue ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Nephron Sparing Surgery ◽

Nephron Sparing

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440 RECURRENCE AFTER NEPHRON-SPARING SURGERY FOR MONOLATERAL CONVENTIONAL RENAL CELL CARCINOMA: EVALUATION ABOUT RISK FACTORS IN 168 PATIENTS WITH LONG-TERM FOLLOW-UP

European Urology Supplements ◽

10.1016/s1569-9056(10)60436-8 ◽

2010 ◽

Vol 9 (2) ◽

pp. 159 ◽

Cited By ~ 1

Author(s):

A. Antonelli ◽

N. Arrighi ◽

T. Zanotelli ◽

L. Perucchini ◽

A. Cozzoli ◽

...

Keyword(s):

Risk Factors ◽

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Nephron Sparing Surgery ◽

Conventional Renal Cell Carcinoma ◽

Nephron Sparing ◽

Long Term Follow Up

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Prognostic importance of resection margin width after nephron-sparing surgery for renal cell carcinoma

Urology ◽

10.1016/s0090-4295(02)01983-0 ◽

2002 ◽

Vol 60 (6) ◽

pp. 993-997 ◽

Cited By ~ 125

Author(s):

Elias A Castilla ◽

Louis S Liou ◽

Neil A Abrahams ◽

Amr Fergany ◽

Lisa A Rybicki ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Resection Margin ◽

Nephron Sparing Surgery ◽

Margin Width ◽

Nephron Sparing ◽

Prognostic Importance

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Impact of pre-existing diabetes mellitus on survival in stage I renal cell carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.6_suppl.676 ◽

2018 ◽

Vol 36 (6_suppl) ◽

pp. 676-676

Author(s):

Stephen Ryan ◽

Ahmet Bindayi ◽

Aaron Bloch ◽

Ryan Nasseri ◽

Zachary Hamilton ◽

...

Keyword(s):

Diabetes Mellitus ◽

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Primary Outcome ◽

Nephron Sparing Surgery ◽

Stage I ◽

Nephron Sparing ◽

The Impact

676 Background: AUA guidelines recommend consideration of nephron sparing surgery in patients with comorbidities that are likely to impact renal function, such as diabetes mellitus (DM). We compared the impact of partial nephrectomy (PN) and radical nephrectomy (RN) on overall survival (OS) in patients with pre-existing DM and Stage I Renal Cell Carcinoma (RCC). Methods: Multicenter retrospective analysis of surgically treated Stage I RCC from 2005-16 with or without DM. Primary outcome was OS analyzed by DM+ or DM- and surgical approach (PN or RN) for AJCC Stage I. Logistic (OR) and Cox (HR) regression were utilized for OS. Results: 2173 patients were analyzed (1223 RN, 1819 PN, 555 DM+, 2487 DM-) with mean follow-up of 49.1 months. Increasing Age (OR 1.028, p = .009), RN (OR 2.446, p = .001), and most recent eGFR < 45 (OR 2.306 p = .002) remained significant on multivariate analysis for OS (Table 1). In the PN subgroup, DM+ or DM- was not associated with decreased OS (HR 1.48 p = 0.19). DM+ was associated with decreased OS in the RN subgroup (HR 1.97 p = 0.005). Conclusions: In Stage I RCC, DM and RN negatively impacted OS, while only RN remained significant on MVA. Subgroup analysis of PN showed that OS was similar in DM- and DM+ patients, but diagnosis of DM had a profound impact on OS in the RN group. This supports the guideline statements and offers evidence that urologists should prioritize nephron sparing surgery in patients with DM and Stage I Renal Cell Carcinoma.[Table: see text]

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Positive margins after nephron-sparing surgery for renal cell carcinoma: long-term follow-up of patients on active surveillance

BJU International ◽

10.1111/j.1464-410x.2009.09174.x ◽

2010 ◽

Vol 106 (5) ◽

pp. 645-648 ◽

Cited By ~ 12

Author(s):

Miguel A. Lopez-Costea ◽

Lluís Fumadó ◽

David Lorente ◽

Luis Riera ◽

Eladio Franco Miranda

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Active Surveillance ◽

Renal Cell ◽

Nephron Sparing Surgery ◽

Positive Margins ◽

Nephron Sparing ◽

Long Term Follow Up

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POSITIVE MARGINS AFTER NEPHRON SPARING SURGERY FOR RENAL CELL CARCINOMA: LONG-TERM FOLLOW-UP OF PATIENTS ON ACTIVE SURVEILLANCE

The Journal of Urology ◽

10.1016/s0022-5347(08)60960-x ◽

2008 ◽

Vol 179 (4S) ◽

pp. 328-328

Author(s):

Miguel A Lopez-Costea ◽

Lluis Fumado ◽

Francesc Vigues ◽

David Lorente ◽

Lluis Riera ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Active Surveillance ◽

Renal Cell ◽

Nephron Sparing Surgery ◽

Positive Margins ◽

Nephron Sparing ◽

Long Term Follow Up

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The safety and efficacy of nephron sparing surgery in T1N0M0 renal cell carcinoma

International Surgery Journal ◽

10.18203/2349-2902.isj20180011 ◽

2018 ◽

Vol 5 (2) ◽

pp. 413

Author(s):

Athar R. Asimi ◽

Mohammad S. Wani ◽

Mohammad I. Lone

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Radical Nephrectomy ◽

Clinical Results ◽

Nephron Sparing Surgery ◽

Positive Surgical Margin ◽

Safety And Efficacy ◽

Nephron Sparing ◽

Duration Of Surgery

Background: Renal cell carcinoma (RCC) accounts for approximately 3% of adult malignancies and 90-95% of neoplasm arising from the kidney. Objective was to explore the safety and efficacy of nephron sparing surgery (NSS) for T1N0M0 renal cell carcinomas (RCC) and to assess the oncological outcome of NSS in T1N0M0 RCC.Methods: A total of 31 cases were enrolled for the study of which 11 (35.5%) underwent NSS and 20 (64.5%) underwent radical nephrectomy (RN). The clinical results were followed up and comparatively analyzed.Results: NSS was performed using a margin of 1cm, no positive surgical margin was detected. The mean blood loss and mean duration of surgery in NSS and RN was comparable. Among all one patient from NSS group experienced urinary leak which was managed by placement of DJ stent. The overall complication rate was 9.1% in NSS. Lab. tests before surgery and after surgery at 6month was done in the both groups and results obtained was within normal limits. Only one patient developed metastasis from NSS group and died at 14th month of fallow-up, whereas neither metastasis nor mortality were recorded in RN group.Conclusions: Nephron sparing SURGERY has proven to be a safe and effective approach for Renal cell carcinoma with comparable clinical results to radical nephrectomy especially in tumour ≤4cm.

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Predictors of renal function in nephron sparing surgery for renal cell carcinoma in solitary kidneys

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e16045 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e16045-e16045

Author(s):

M. Wosnitzer ◽

D. J. Lee ◽

A. J. Hirsch ◽

J. M. McKiernan

Keyword(s):

Renal Cell Carcinoma ◽

Renal Failure ◽

Renal Function ◽

Cell Carcinoma ◽

Renal Cell ◽

Tumor Stage ◽

Nephron Sparing Surgery ◽

Tumor Diameter ◽

Nephron Sparing ◽

The Mean

e16045 Background: Partial nephrectomy (PN) is an effective option for the treatment of renal cell carcinoma (RCC) in patients who need to preserve renal function. However, the oncologic safety and functional outcome after PN in solitary kidneys have not been fully examined. We assessed the outcomes after PN, and evaluated predictors of post-operative renal function. Methods: A retrospective analysis of the Columbia Urologic Oncology database found 1327 patients were treated for RCC from 1988 - 2008, of whom 38 consecutive patients underwent PN on a solitary kidney. Glomerular filtration rate (GFR) was estimated with the Modification of Diet in Renal Disease (MDRD) equation. Severe chronic kidney disease (CKD) and renal failure were defined as GFR of 15–30 cc/min/1.73m2 and GFR<15, respectively. Cox proportional hazards regression methods were used. Results: The study group included 30 men and 8 women with unilateral RCC. The mean age was 63.2 years (range 35–83). The mean estimated blood loss was 465cc, the mean tumor diameter was 3.9cm, and 6 (17%) of the patients had a positive surgical margin. 9 patients (30%) had recurrence of RCC at a mean of 23 months postoperatively. Recurrence occurred in the kidneys of 4 patients, lung in 3 patients, bone in 3 patients, and the ipsilateral adrenal gland in one patient. The mean preoperative GFR was 55.6, and the GFR decreased postoperatively by an average of 14.2%. No patients required postoperative hemodialysis. Preoperative GFR (HR=1.01, p<0.01) and the volume of kidney removed (HR=0.93, p=0.01) were associated with severe CKD and renal failure on a univariate Cox regression analysis, but were not independent predictors after adjusting for age, race, tumor stage and grade. Preoperative GFR, volume removed, age, tumor stage or grade were not independent predictors of RCC recurrence. Conclusions: PN in solitary kidneys pose difficult challenges for surgical and clinical management. Nephron sparing surgery for the treatment of RCC is feasible with acceptable morbidity and renal function outcome. The volume of renal parenchyma removed and the preoperative GFR are associated with renal function loss several months after surgery, and may be useful in predicting long-term renal function. No significant financial relationships to disclose.

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