Renal functional outcomes after surgery for renal cortical tumors

Historically, radical nephrectomy represented the gold standard for the treatment of small (? 4cm) as well as larger renal masses. Recently, for small renal masses, the risk of ensuing chronic kidney disease and end stage renal disease has largely favored nephron-sparing surgical techniques, mainly partial nephrectomy. In this review, we surveyed the literature on renal functional outcomes after partial nephrectomy for renal tumors. The largest randomized control trial comparing radical and partial nephrectomy failed to show a survival benefit for partial nephrectomy. With regards to overall survival, surgically induced chronic kidney disease (GFR < 60 ml/min/ 1.73m2) caused by nephrectomy might not be as deleterious as medically induced chronic kidney disease. In evaluating patients who underwent donor nephrectomy, transplant literature further validates that surgically induced reductions in GFR may not affect patient survival, unlike medically induced GFR declines. Yet, because patients who present with a renal mass tend to be elderly with multiple comorbidities, many develop a mixed picture of medically, and surgically-induced renal disease after extirpative renal surgery. In this population, we believe that nephron sparing surgery optimizes oncological control while protecting renal function.

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

International Surgery ◽

10.9738/intsurg-d-15-00226.1 ◽

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.

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1526 ECONOMIC AND CLINICAL CONSEQUENCES OF NEW ONSET POST-OPERATIVE CHRONIC KIDNEY DISEASE FOLLOWING RADICAL AND PARTIAL NEPHRECTOMY IN THE MANAGEMENT OF SMALL RENAL MASSES

The Journal of Urology ◽

10.1016/j.juro.2011.02.1519 ◽

2011 ◽

Vol 185 (4S) ◽

Cited By ~ 2

Author(s):

Steven L Chang ◽

Lauren E Cipriano ◽

Steven M Brunelli ◽

Benjamin I Chung

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Partial Nephrectomy ◽

Small Renal Masses ◽

Renal Masses ◽

Clinical Consequences ◽

New Onset

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The Screening for Occult Renal Disease (SCORED) Value Is Associated With a Higher Risk for Having or Developing Chronic Kidney Disease in Patients Treated for Small, Unilateral Renal Masses

Yearbook of Urology ◽

10.1016/s0084-4071(09)79257-7 ◽

2009 ◽

Vol 2009 ◽

pp. 107-109

Author(s):

A.S. Kibel

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Renal Disease ◽

Renal Masses

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Robotic Partial Nephrectomy for Small Renal Masses in Patients With Pre-existing Chronic Kidney Disease

Urology ◽

10.1016/j.urology.2012.05.038 ◽

2012 ◽

Vol 80 (4) ◽

pp. 845-851 ◽

Cited By ~ 18

Author(s):

Julien Guillotreau ◽

Rachid Yakoubi ◽

Jean-Alexandre Long ◽

Joseph Klink ◽

Riccardo Autorino ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Partial Nephrectomy ◽

Robotic Partial Nephrectomy ◽

Small Renal Masses ◽

Renal Masses

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The economic and clinical costs of chronic kidney disease following radical and partial nephrectomy in the management of small renal masses.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.7_suppl.353 ◽

2011 ◽

Vol 29 (7_suppl) ◽

pp. 353-353

Author(s):

S. L. Chang ◽

L. E. Cipriano ◽

L. C. Harshman ◽

B. I. Chung

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Health Outcomes ◽

Partial Nephrectomy ◽

Base Case ◽

Small Renal Masses ◽

Renal Masses ◽

Lifetime Horizon ◽

Life Years ◽

The Impact

353 Background: Postoperative chronic kidney disease (PCKD), defined as a glomerular filtration rate of < 60mL/min/1.73m2, is a recognized adverse outcome after extirpative therapy for small renal masses (SRM, ≤ 4cm). We quantified the long-term economic and clinical costs of PCKD following radical and partial nephrectomy for the management of SRM. Methods: Using a Markov model, we evaluated open and laparoscopic approaches for radical and partial nephrectomy in the treatment of SRMs. The base case was a 65-year old healthy individual with a unilateral SRM and normal renal function. We used a 3-month cycle length, lifetime horizon, societal perspective, and 3% discount rate. The costs, quality of life adjustments, and transition probabilities were estimated from the literature, Medicare, and expert opinion. Health outcomes were measured in quality-adjusted life-years (QALY) gained and costs in 2008 U.S. dollars. The model was tested with sensitivity analyses. Results: The average discounted lifetime outcomes are listed in the Table. There were minimal differences between the open and laparoscopic approaches. PCKD led to a substantial increase costs and decrease in health outcomes. The impact of PCKD was indirectly associated with age. Conclusions: Partial nephrectomy provides cost-savings and improved health outcomes compared to radical nephrectomy in the management of patients with SRMs. Both procedures incur significant economic and clinical costs due to the development of PCKD. A discussion about the potential for PCKD should be incorporated into the informed consent for surgical treatment of SRMs. [Table: see text] No significant financial relationships to disclose.

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