Morbidity and clinical outcome of nephron-sparing surgery in relation to tumour size and indication

objective: To analyse through a large multicentre series, morbidity of nephron-sparing surgery (NSS) in relation to turnour size and surgical indication. Methods: The study included patients from eight international academic centres. Age, sex, TNM stage, tumour size, Fuhrman grade, Eastern Cooperative Oncology Group performance status (ECOG-PS), surgical margins, local and distant recurrences, and overall and cancer-specific survival rates were collected and analysed. Indication for elective or mandatory NSS, medical and surgical complication rates, mean blood loss, blood transfusion, and length of hospital stay were specifically recorded for the purpose of this study. Groups were compared for qualitative and quantitative variables by using chi(2) (Fischer exact test) and Student t tests, respectively. Results: A total of 1048 NSS procedures were included in this study. Mean turnour size was 3.4 +/- 2.1 cm. In 730 elective procedures mean operative time (p = 0.002), mean blood loss (p = 0.01), the need for blood transfusion (p = 0.001), and urinary fistula rate (p = 0.01) were significantly increased for tumours >4 cm. However, these differences did not result in significantly increased medical (p = 0.4), surgical complication rates (p = 0.6), or length of hospital stay (p = 0.9). Finally, in elective procedures for malignant tumours, positive surgical margins, local or distant recurrence rates, and cancer-specific survival were not significantly different in tumours <= 4 cm and >4 cm. Conclusion: Excellent cancer control and outcomes can be achieved with NSS in carefully selected patients with tumours >4 cm. Expanding the size indication of elective NSS results in an increased but acceptable morbidity. (c) 2007 European Association of Urology. Published by Elsevier B.V. All rights reserved.