Treatment of Localised Renal Cell Carcinoma

Poppel, Hendrik Van; Becker, Frank; Cadeddu, Jeffrey A.; Gill, Inderbir S.; Janetschek, G.; Jewett, Michael A.S.; Laguna, M. Pilar; Marberger, Michael; Montorsi, Francesco; Polascik, Thomas J.; Ukimura, Osamu; Zhu, Gang

doi:10.1016/j.eururo.2011.06.040

Cited by 210 publications

(135 citation statements)

References 137 publications

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“…This organ-preserving approach has recently emerged as a viable alternative for small renal tumours (< 4cm or T1a) in patients with a normal contralateral kidney, with encouraging short-term and long-term oncological outcomes [10,11]. The era of increasing use of nephron-sparing surgery has also witnessed the development of minimally invasive nephron-sparing interventions such as cryoablation, radiofrequency ablation (RFA) and highintensity focused ultrasound (HIFU), for the treatment of localised renal cancer [10,11].…”

Section: Introductionmentioning

confidence: 99%

Systematic Review of Oncological Outcomes Following Surgical Management of Localised Renal Cancer

MacLennan

Imamura

Lapitan³

et al. 2012

European Urology

291

170

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Context: Renal cell carcinoma (RCC) accounts for 2-3% of adult malignancies. There remain uncertainties over the oncological outcomes for the surgical management of localised RCC. Objective: To systematically review relevant literature comparing oncological outcomes of surgical management of localised RCC (T1-2N0M0). Evidence Acquisition: Relevant databases including MEDLINE, Embase and the Cochrane Library were searched up to October 2010, and an updated scoping search was performed up to January 2012. Randomised or quasi-randomised controlled trials (RCTs), prospective observational studies with controls, retrospective matched-pair studies, and comparative studies from well defined registries/databases were included. The main outcomes were overall survival, cancer-specific survival, recurrence and metastases. The Cochrane risk of bias (RoB) tool was used to assess RCTs and an extended version was used to assess Non Randomised Studies (NRS). The quality of evidence was assessed using GRADE. Evidence Synthesis: 4580 abstracts and 389 full text articles were assessed. 34 studies met the inclusion criteria (6 RCTs and 28 NRSs). Meta-analyses were planned but were deemed inappropriate due to data heterogeneity. There were high risks of bias and low quality evidence across the evidence base. Open radical nephrectomy and open partial nephrectomy showed similar cancer-specific and overall survival, but when both open and laparoscopic approaches are considered together the evidence showed improved survival for partial nephrectomy for tumours ≤4cm.Overall, the evidence suggests either equivalent or better survival with partial nephrectomy. Laparoscopic radical nephrectomy offered equivalent survival to open radical nephrectomy, and all laparoscopic approaches achieved equivalent survival. Open and laparoscopic partial nephrectomy achieved equivalent survival. The issue of ipsilateral adrenalectomy or complete lymph node dissection with radical nephrectomy or partial nephrectomy remains unresolved. Conclusions: The evidence base suggests localised RCC are best managed by nephron sparing surgery where technically feasible. However, the current evidence base has significant limitations due to studies of low methodological quality marked by high risks of bias.

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Section: Introductionmentioning

confidence: 99%

Systematic Review of Oncological Outcomes Following Surgical Management of Localised Renal Cancer

MacLennan

Imamura

Lapitan³

et al. 2012

European Urology

291

170

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“…Onkolojik sonuçlardan ödün vermeden tedavi kararını belirlerken dikkat edilmesi gereken en önemli husus, böbrek fonksiyonlarının korunmasıdır. Bu bağlamda böbreğe lokalize RHK'nin güncel tedavisi; mükemmel sağkalım ve yüz güldürücü onkolojik sonucu nedeniyle NKC'dir (19). Avrupa ve Amerika Üroloji Dernekleri'nin kılavuzlarında T1 böbrek tümörü tedavisinde artık NKC altın standart yöntem olmuş ve komorbiditesi nedeniyle cerrahisi riskli olan hastalarda ablatif yöntemler ve izlem kendine yer bulmuştur (1,20).…”

Section: Discussionunclassified

The Effects of Radical Nephrectomy and Nephron Sparing Surgery on Glomerular Filtration Rate for the Patients who Underwent Surgery for Localized Renal Mass

Güdeloğlu¹,

Akdoğan²

2016

Acta Oncol Tur.

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ÖZETAmaç: Bu çalışmada, radikal nefrektomi (RN) ile nefron koruyucu cerrahinin (NKC) uzun dönem böbrek fonksiyonları üzerine etkisini ortaya koymak amaçlanmıştır. Hastalar veYöntem: Hacettepe Üniversitesi Tıp Fakültesi Üroloji Anabilim Dalı'nda Ocak 1990 -Nisan 2011 tarihleri arasında renal kitle nedeniyle ameliyat edilen 1016 hastaya ait veriler, retrospektif olarak incelenmiştir. Tanı anında metastatik olduğu bilinen 78 olgu çalışma dışı tutulmuştur. Bulgular: Çalışmaya alınan olguların 579'u (%61,7) erkek ve 359'u (%38,3) kadındır. 624 olguya RN, 314 olguya NKC yapılmıştır. Hastaların ortalama takip süresi RN yapılan grupta 46.7 ay iken, NKC uygulanan grupta 39.9 aydır. Ortalama radyolojik tümör boyutu sırasıyla 75±33,5 mm ve 37,8±26 mm'dir (p<0.001). Ortalama ameliyat süresi RN ve NKC grupları için sırasıyla 137.6 ve 139.5 dakikadır. NKC uygulanan grupta ortalama sıcak iskemi süresi 18,9±6,8 (3-36) dakikadır. Uzun dönem takip sonunda RN yapılan gruptaki kreatinin değerindeki ortalama 0,51 mg/dl artış, NKC uygulanan gruptaki 0,39 mg/dl artıştan anlamlı şekilde daha fazladır (p<0.001). Uzun dönem takipte preoperatif GFR'ı ≥60 olan hastaların halen GFR değerinin ≥60 olarak devam etme oranları, RN ve NKC yapılan gruplarda sırasıyla %47.6 ve %74.8 olarak tespit edilmiştir (p<0.001). Sonuç: Çalışmamızda GFR'de azalma oranının uzun dönemde RN yapılan hastalarda NKC yapılanlara göre daha fazla olduğu bulunmuştur. T1 renal tümörü olan birçok olguda RN ile bütün böbreği çıkarmak fazladan tedavidir. T1 renal tümörü olan hastalarda teknik olarak mümkün oldukça parsiyel nefrektomi tercih edilmelidir. Anahtar kelimeler: Renal Hücreli Karsinom, Radikal Nefrektomi, Nefron Koruyucu Cerrahi, Glomerüler Filtrasyon Oranı ABSTRACT Objectives: The goal of this study was to demonstrate the long-term effects of radical nephrectomy (RN) and nephron sparing surgery (NSS) on kidney functions. Patients and Methods: The medical records of 1016 patients who underwent kidney surgery from January 1990 to April 2011 at Hacettepe University School of Medicine, Department of Urology were retrospectively collected and analyzed. Metastatic 78 patients at presentation were excluded. Results: Radical nephrectomy and nephron sparing surgery was performed in 624 and 314 cases, respectively. Male to female ratio was 579/314. The mean follow up was 46.7 and 39.9 months for RN and NSS, respectively. The mean radiological tumor size was 75±33,5 mm for RN and 37,8±26 mm for NSS (p<0.001). The mean duration of surgery for RN and NSS was 137 and 139 minutes, respectively. The mean warm ischemia time for NSS was 18.9 minutes. Serum creatinin level was increased 0.51mg/dl and 0.39mg/dl for RN and NSS after long-term follow up, respectively (p<0.001). Glomerular filtration rate (GFR) was ≥ 60 ml/min/m 2 in 47.6% and 74.8% of RN and NSS patients in long-term follow up, respectively (p<0.001). Conclusion: Decrease in GFR was more prominent in RN compared to NSS patients in long term. Therefore, removing the whole kidney for especially T1 renal tumours is over ...

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“…The low possibility of malignancy and the relative indolent behaviour of the majority of SRMs makes radical nephrectomy a very aggressive treatment option even more so considering that partial nephrectomy provides equivalent oncological efficacy [8]. There is a known association between CKD and cardiovascular morbidity (CAD, MI, peripheral arterial disease), hospitalization and death [9].…”

Section: The Morbidity Of Radical Nephrectomymentioning

confidence: 99%

Commentary: Partial Nephrectomy for the Management of Small Renal Masses

Sountoulides¹

2015

UNOAJ

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It is estimated that approximately 20% of SRMs are benign. The majority (55-60%) of those considered "malignant" exhibit a rather indolent clinical behaviour and only about 20-25% demonstrate an aggressive clinical course. The risk of malignancy is related to the diameter of a tumour. It has been shown that 46% of tumours smaller than 1 cm in diameter are benign and only 2.3% of them are high grade [6]. It has also been estimated that an increase of 1cm in diameter correlates with a 16% increase in the risk of malignancy [7]. The Morbidity of Radical NephrectomyRecently there has been significant controversy regarding the indications for radical nephrectomy in the management of T1 stage renal tumours, especially SRMs. The low possibility of malignancy and the relative indolent behaviour of the majority of SRMs makes radical nephrectomy a very aggressive treatment option even more so considering that partial nephrectomy provides equivalent oncological efficacy [8]. There is a known association between CKD and cardiovascular morbidity (CAD, MI, peripheral arterial disease), hospitalization and death [9]. Studies have shown that radical nephrectomy is associated with a 22% risk of developing CKD at 10 years of follow up (defined as eGFR<60ml/min/1.73m2 and/or creatinine>2mg/dl) compared to a 12% risk of CKD for partial nephrectomy [10,11]. Huang et al showed that the possibility of maintaining a normal renal function (GFR>60ml/min/1.73m2) at 10 years of follow up is 80% for partial nephrectomy compared to only 35% for radical nephrectomy [12].Chang et al. [13] used the analytical Markov model of a 65-year old patient with a unilateral small renal tumor and normal renal function in order to predict the long-term outcomes of partial versus radical nephrectomy. The study showed that partial nephrectomy is more cost-effective and provides better quality of life compared to radical nephrectomy for patients with SRMs mainly due to the lower risk of CKD. The issue of mortality following radical nephrectomy for SRMs was addressed in a study using data from the SEER database. 4.216 patients with renal tumors smaller than 2 cm were subjected to either partial nephrectomy (PN) or radical nephrectomy (RN) and followed for 10 years. The study revealed an exponential increase in the utilization of PN, from 27% in 1998 to 66% in 2007. The study findings corroborated that RN is associated with a worst overall survival and an increased cardiovascular morbidity compared to partial nephrectomy for renal masses smaller than 2 cm [14].Current guidelines state that partial nephrectomy is an absolute indication in cases of a localized renal tumour in a patient for whom radical nephrectomy would necessitate renal dialysis [15,16]. This clinical scenario applies not only to cases of bilateral renal tumours but also to those of a unilateral renal tumour in the presence of a contralateral anatomically or functionally compromised kidney. A recent review article, considered a total of 27 publications from 1995 to 2010, relevant to PN and RN fo...

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Treatment of Localised Renal Cell Carcinoma

Cited by 210 publications

References 137 publications

Systematic Review of Oncological Outcomes Following Surgical Management of Localised Renal Cancer

Systematic Review of Oncological Outcomes Following Surgical Management of Localised Renal Cancer

The Effects of Radical Nephrectomy and Nephron Sparing Surgery on Glomerular Filtration Rate for the Patients who Underwent Surgery for Localized Renal Mass

Commentary: Partial Nephrectomy for the Management of Small Renal Masses

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