TY  - JOUR
A1  - Janssen, Martin Wilhelm Walter
A1  - Linxweiler, Johannes
A1  - Terwey, S.
A1  - Rugge, Sven
A1  - Ohlmann, Carsten-Henning
A1  - Becker, Frank
A1  - Neisius, Andreas
A1  - Thüroff, Joachim W.
A1  - Siemer, Stefan
A1  - Stöckle, Michael
A1  - Roos, Frederik
T1  - Survival outcomes in patients with large (≥7cm) clear cell renal cell carcinomas treated with nephron-sparing surgery versus radical nephrectomy : results of a multicenter cohort with long-term follow-up
T2  - PLoS One
N2  - Background: Does the dogma of nephron sparing surgery (NSS) still stand for large renal masses? Available studies dealing with that issue are considerably biased often mixing imperative with elective indications for NSS and also including less malignant variants or even benign renal tumors. Here, we analyzed the oncological long-term outcomes of patients undergoing elective NSS or radical tumor nephrectomy (RN) for non-endophytic, large (≥7cm) clear cell renal carcinoma (ccRCC).
Methods: Prospectively acquired, clinical databases from two academic high-volume centers were screened for patients from 1980 to 2010. The query was strictly limited to patients with elective indications. Surgical complications were retrospectively assessed and classified using the Clavien-Dindo-classification system (CDS). Overall survival (OS) and cancer specific survival (CSS) were analyzed using the Kaplan-Meier-method and the log-rank test.
Results: Out of in total 8664 patients in the databases, 123 patients were identified (elective NSS (n = 18) or elective RN (n = 105)) for ≥7cm ccRCC. The median follow-up over all was 102 months (range 3–367 months). Compared to the RN group, the NSS group had a significantly longer median OS (p = 0.014) and median CSS (p = 0.04).
Conclusions: In large renal masses, NSS can be performed safely with acceptable complication rates. In terms of long-term OS and CSS, NSS was at least not inferior to RN. Our findings suggest that NSS should also be performed in patients presenting with renal tumors ≥7cm whenever technically feasible. Limitations include its retrospective nature and the limited availability of data concerning long-term development of renal function in the two groups.
KW  - Surgical and invasive medical procedures
KW  - Surgical oncology
KW  - Oncology
KW  - Radical nephrectomy
KW  - Nephrons
KW  - Renal cancer
KW  - Survival analysis
KW  - Renal system
Y1  - 2018
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/46558
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-465582
SN  - 1932-6203
N1  - Copyright: © 2018 Janssen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
VL  - 13
IS  - (5): e0196427
SP  - 1
EP  - 13
PB  - PLoS
CY  - Lawrence, Kan.
ER  -