Nephron-Sparing Surgery for Renal Tumors Measuring More Than 7 cm: Morbidity, and Functional and Oncological Outcomes

被引：27

作者：

Bigot, Pierre ^{[1
,2
]}

Hetet, Jean-Francois ^{[1
,3
]}

Bernhard, Jean-Christophe ^{[1
,4
]}

Fardoun, Tarek ^{[5
]}

Audenet, Francois ^{[6
]}

Xylinas, Evanguelos ^{[7
]}

Ploussard, Guillaume ^{[8
]}

Pignot, Geraldine ^{[1
,9
]}

Bessede, Thomas ^{[9
]}

Ouzaid, Idir ^{[10
]}

Robine, Edouard ^{[11
]}

Brureau, Laurent ^{[12
]}

de Treigny, Olivier Merigot ^{[13
]}

Maurin, Charlotte ^{[9
]}

Long, Jean-Alexandre ^{[1
,14
]}

Rouffilange, Jean ^{[4
]}

Hoarau, Nicolas ^{[2
]}

Lebdai, Souhil ^{[2
]}

Roupret, Morgan ^{[1
,6
]}

Bastien, Laurence ^{[8
]}

Neuzillet, Yann ^{[1
,12
]}

Mongiat-Artus, Pierre ^{[8
]}

Verhoest, Gregory ^{[5
]}

Zerbib, Marc ^{[7
]}

Ravery, Vincent ^{[10
]}

Rigaud, Jerome ^{[1
,11
]}

Bellec, Laurent ^{[13
]}

Baumert, Herve ^{[1
,15
]}

Chautard, Denis ^{[2
]}

Bensalah, Karim ^{[1
,5
]}

Escudier, Bernard ^{[1
,16
]}

Paparel, Philippe ^{[1
,17
]}

Grenier, Nicolas ^{[1
,18
]}

Rioux-Leclercq, Nathalie ^{[1
,19
]}

Azzouzi, Abdel-Rahmene ^{[2
]}

Soulie, Michel ^{[1
,13
]}

Patard, Jean-Jacques ^{[1
,9
]}

机构：

[1] French Assoc Urol CCAFU, Cancerol Comm, Paris, France

[2] Angers Univ Hosp, Dept Urol, Angers, France

[3] Clin Jules Verne, Dept Urol, Nantes, France

[4] Pellegrin Univ Hosp, Dept Urol, Bordeaux, France

[5] Pontchaillou Univ Hosp, Dept Urol, Rennes, France

[6] La Pitie Salpetriere Univ Hosp, Dept Urol, Paris, France

[7] Paris Descartes Univ, Cochin Hosp, AP HP, Paris, France

[8] St Louis Univ Hosp, AP HP, Dept Urol, Paris, France

[9] Bicetre Univ Hosp, Dept Urol, Le Kremlin Bicetre, France

[10] Hop Xavier Bichat, AP HP, Dept Urol, Paris, France

[11] Nantes Univ Hosp, Dept Urol, Nantes, France

[12] Foch Univ Hosp, Dept Urol, Suresnes, France

[13] Toulouse Univ Hosp, Dept Urol, Toulouse, France

[14] Grenoble Univ Hosp, Dept Urol, Grenoble, France

[15] St Joseph Hosp, Dept Urol, Paris, France

[16] Inst Gustave Roussy, Dept Med Oncol, Villejuif, France

[17] Lyon Sud Univ Hosp, Dept Urol, Lyon, France

[18] Pellegrin Univ Hosp, Dept Radiol, Bordeaux, France

[19] Pontchaillou Univ Hosp, Dept Pathol, Rennes, France

来源：

CLINICAL GENITOURINARY CANCER | 2014年 / 12卷 / 01期

关键词：

Complications; Functional outcome; Nephron sparing surgery; Oncologic outcome; Renal cell carcinoma Surgical treatment; CHRONIC KIDNEY-DISEASE; CELL CARCINOMA; RADICAL NEPHRECTOMY; PRACTICE GUIDELINES; CLASSIFICATION; SURVIVAL; IMPACT; SIZE; PREDICTION;

D O I：

10.1016/j.clgc.2013.09.004

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Nephron-sparing surgery (NSS) is recommended for renal tumors < 7 cm and allows better overall survival with oncological results similar to radical nephrectomy. We retrospectively analyzed data from 168 patients treated using NSS for large tumors. In this selected population, patients with elective indication had favorable oncological and morbidity outcomes. NSS indications could be expanded beyond the 7 cm cutoff. Background: The purpose of this study was to evaluate morbidity, functional, and oncological outcomes after NSS in renal tumors > 7 cm. Materials and Methods: We retrospectively analyzed data from 168 patients with tumors > 7 cm who were treated using NSS between 1998 and 2012. Results: Imperative and elective indications accounted for 76 (45.2%) and 92 (54.8%) patients, respectively. Major perioperative complications and renal function deterioration occurred in 33 (19.6%) and 51 patients (30.4%), respectively. In multivariate analysis, age older than 60 years (P=.001; hazard ratio [HR], 5) and tumor malignancy (P=.014; HR, 6.7) were prognostic factors for renal function deterioration whereas imperative indication was a risk factor for major postoperative complications (P=.0019; HR, 2.7). In 126 (75%) patients with malignant tumors, after a median follow-up of 30 months (range, 1-254 months), 25 patients (20.2%) died. In multivariate analysis, imperative indication (P=.023; HR, 4.2), positive surgical margin (P=.021; HR, 3.3), and Fuhrman grade > II (P=.013; HR, 3.7) were prognostic indicators for cancer-free survival (CFS). Imperative indication (P=.04; HR, 8.5) and Fuhrman grade > II (P=.04; HR, 3.9) were predictive factors of cancer-specific survival (CSS). In case of elective indication, positive surgical margin, local recurrence, and cancer-related death occurred in 4 (7.6%), 1 (1.1%), and 1 (1.1%) cases, respectively. For elective indication, 5-year estimates of CFS, CSS, and overall survival rates were: 85.7%, 98%, and 93.9%, respectively. Conclusion: In this selected population, imperative vs. elective indication status seems to play a critical role in oncologic outcomes. Oncologic results for elective indications are close to those reported with radical nephrectomy. (C) 2014 Elsevier Inc. All rights reserved.

引用

页码：E19 / E27

页数：9

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