Nephron Sparing Surgery for Small Renal Mass at a University Teaching Hospital: A Six Years Retrospective Review

Introduction: Nephron-sparing surgery (NSS) is the standard of care for clinical T1 (cT1), renal mass less than 7 cm, whenever intervention is indicated. It has ontological outcome equivalent to radical nephrectomy in small renal masses and it also minimizes the progression to chronic kidney disease. However, there is paucity of data on outcomes of NSS in Nepalese population. Methods: A six years retrospective review of medical records of patients undergoing partial nephrectomy from Jan 2012 to Dec 2017 in Department of Urology and Kidney Transplant Surgery at Tribhuvan University Teaching Hospital was done to determine its demographics and outcomes. Results: Twenty eight patients underwent nephron sparing surgery for clinical T1 renal masses in the past six years. Complications occurred in three cases. Five of the lesions were benign and 23 malignant on final histology. Clear cell carcinoma was the commonest variant of renal cell cancer. Margin was positive in two cases and both were kept in close surveillance. There was no local recurrence and renal impairment during five to 60 months follow up. Conclusion: Nephron sparing surgery is a safe procedure with good oncological outcome for clinical T1 renal mass. It prevents unnecessary nephrectomy in benign lesions as well as chronic renal impairment at the same time.

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The Natural History and Predictors for Intervention in Patients with Small Renal Mass Undergoing Active Surveillance

Advances in Urology ◽

10.1155/2015/692014 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 11

Author(s):

Zaher Bahouth ◽

Sarel Halachmi ◽

Gil Meyer ◽

Ofir Avitan ◽

Boaz Moskovitz ◽

...

Keyword(s):

Natural History ◽

Active Surveillance ◽

Renal Mass ◽

Nephron Sparing Surgery ◽

Small Renal Mass ◽

Small Renal Masses ◽

Renal Masses ◽

Nephron Sparing ◽

The Mean

Aim. To describe the natural history of small renal mass on active surveillance and identify parameters that could help in predicting the need for intervention in patients with small renal masses undergoing active surveillance. We also discuss the need for renal biopsy in the management of these patients.Methods. A retrospective analysis of 78 renal masses ≤4 cm diagnosed at our Urology Department at Bnai Zion Medical Center between September 2003 and March 2012.Results. Seventy patients with 78 small renal masses were analyzed. The mean age at diagnosis was 68 years (47–89). The mean follow-up period was 34 months (12–112). In 54 of 78 masses there was a growth of at least 2 mm between imaging on last available follow-up and diagnosis. Eight of the 54 (15%) masses which grew in size underwent a nephron-sparing surgery, of which two were oncocytomas and six were renal cell carcinoma. Growth rate and mass diameter on diagnosis were significantly greater in the group of patients who underwent a surgery.Conclusions. Small renal masses might eventually be managed by active surveillance without compromising survival or surgical approach. All masses that were eventually excised underwent a nephron-sparing surgery. None of the patients developed metastases.

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

Urologic Oncology Seminars and Original Investigations ◽

10.1016/j.urolonc.2015.04.016 ◽

2015 ◽

Vol 33 (10) ◽

pp. 427.e11-427.e16 ◽

Cited By ~ 7

Author(s):

Zaher Bahouth ◽

Sarel Halachmi ◽

Itamar Getzler ◽

Orna Caspin ◽

Boaz Moskovitz ◽

...

Keyword(s):

Nephron Sparing Surgery ◽

Renal Masses ◽

Oncological Outcomes ◽

Nephron Sparing

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Superselective Embolization of Arterial Bleeding as a Late Complication 3 Months After Nephron Sparing Surgery for Renal Cell Carcinoma

The Scientific World JOURNAL ◽

10.1100/tsw.2004.88 ◽

2004 ◽

Vol 4 ◽

pp. 350-352

Author(s):

J. Thomas ◽

F.G.E. Perabo ◽

R. Bachmann ◽

G. Steiner ◽

H. Schild ◽

...

Keyword(s):

Renal Cell ◽

Late Complication ◽

Cell Cancer ◽

Invasive Procedure ◽

Nephron Sparing Surgery ◽

First Case ◽

Arterial Bleeding ◽

Nephron Sparing ◽

Superselective Embolization ◽

Arterial Branch

To our knowledge, this is the first case of an arterial bleeding as a late complication 3 months after nephron sparing surgery of renal cell cancer, presumably originating from an arteriocalyceal fistula. Superselective embolization of the feeding arterial branch was chosen for treatment of the hemorrhage and proved successful. The high efficacy of superselective embolization as a minimally invasive procedure in this and other cases of bleeding Vessels should be the preferred method instead of open surgery.

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Renal function and oncologic outcomes in nephron sparing surgery for renal masses in solitary kidneys

World Journal of Urology ◽

10.1007/s00345-010-0576-9 ◽

2010 ◽

Vol 29 (3) ◽

pp. 343-348 ◽

Cited By ~ 13

Author(s):

Daniel J. Lee ◽

Greg Hruby ◽

Mitchell C. Benson ◽

James M. McKiernan

Keyword(s):

Renal Function ◽

Nephron Sparing Surgery ◽

Oncologic Outcomes ◽

Renal Masses ◽

Nephron Sparing

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Re: Population-Based Comparative Effectiveness of Nephron-Sparing Surgery vs Ablation for Small Renal Masses

The Journal of Urology ◽

10.1016/j.juro.2012.12.054 ◽

2013 ◽

Vol 189 (4) ◽

pp. 1286-1286

Author(s):

Jeffrey A. Cadeddu

Keyword(s):

Comparative Effectiveness ◽

Population Based ◽

Nephron Sparing Surgery ◽

Small Renal Masses ◽

Renal Masses ◽

Nephron Sparing

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Is radical nephrectomy a legitimate therapeutic option in patients with renal masses amenable to nephron-sparing surgery?

BJU International ◽

10.1111/bju.12696 ◽

2014 ◽

Vol 115 (3) ◽

pp. 357-363 ◽

Cited By ~ 15

Author(s):

Jeffrey J. Tomaszewski ◽

Marc C. Smaldone ◽

Robert G. Uzzo ◽

Alexander Kutikov

Keyword(s):

Radical Nephrectomy ◽

Therapeutic Option ◽

Nephron Sparing Surgery ◽

Renal Masses ◽

Nephron Sparing

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Elective open nephron-sparing surgery for renal masses: Single-center experience with 223 consecutive patients

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e16139 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e16139-e16139

Author(s):

F. Francesca ◽

G. Pomara ◽

G. Campo ◽

P. Casale

Keyword(s):

Postoperative Bleeding ◽

Oncologic Outcome ◽

Nephron Sparing Surgery ◽

Consecutive Series ◽

Renal Masses ◽

Single Center Experience ◽

Nephron Sparing ◽

Urinary Fistulas

e16139 Background: To present our experience with elective, open, nephron-sparing surgery for renal masses in a contemporary, consecutive series. Methods: In this retrospective study, records of all patients who underwent elective nephron-sparing surgery (E-NSS) between March 1997 and December 2007 at our institution were reviewed. The preoperative workup included laboratory analysis, renal ultrasonography and abdominal computed tomography. The histological findings, complications, and oncologic outcome were studied. Results: A total of 231 E-NSS were performed in 223 patients (82 females,141males; mean age 64 years). 62 “hot ischemia” procedures and 169 “cold ischemia”. The mean tumor size was 4.6 cm (1.1–12cm). 52 patients presented renal masses > 4cm. Renal cell carcinoma was present in 177 patients (76.6%), benign renal masses were diagnosed in in 54 pazienti (23.3%): angiomyolipoma (35%), oncocytoma (40%), complicated cyst (25%). Worthy of note among these 54 patients, pre-operative diagnosis was present in 12 patients. Moreover, 17 benign lesions (31%) were > 4 cm. Complication rate was 5.3% (12 pts): splenectomy (2.2%), nephrectomy because of postoperative bleeding (0.8%), urinary fistulas (0.8%). After a median follow-up of 84 months (range 5 to 120), no patient had developed local recurrence, 19 (8.9%) died for other causes, 2 (0.9%) died for other tumor. Conclusions: The results of this contemporary, monocenter experience underline the role of open, elective, nephron-sparing surgery for patients with renal masses, confirming good results even for renal masses > 4cm. These conclusions are particularly important considering that benign histologic findings were present in almost one forth of patients. No significant financial relationships to disclose.

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