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

  • 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.
Author:Martin Wilhelm Walter JanssenORCiDGND, Johannes Linxweiler, S. Terwey, Sven Rugge, Carsten-Henning Ohlmann, Frank Becker, Andreas Neisius, Joachim W. Thüroff, Stefan Siemer, Michael Stöckle, Frederik RoosGND
Pubmed Id:
Parent Title (English):PLoS One
Place of publication:Lawrence, Kan.
Contributor(s):Christian Schwentner
Document Type:Article
Year of Completion:2018
Date of first Publication:2018/05/03
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2018/05/24
Tag:Nephrons; Oncology; Radical nephrectomy; Renal cancer; Renal system; Surgical and invasive medical procedures; Surgical oncology; Survival analysis
Issue:(5): e0196427
Page Number:13
First Page:1
Last Page:13
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.
Institutes:Medizin / Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - Namensnennung 4.0