Long-Term Outcomes After Nephron Sparing Surgery for Renal Cell Carcinoma Larger Than 4 cm

Peycelon, Matthieu; Hupertan, Vincent; Comperat, Eva; Renard-Penna, Raphaële; Vaessen, Christophe; Conort, Pierre; Bitker, Marc-Olivier; Chartier-Kastler, Emmanuel; Richard, François; Rouprêt, Morgan

doi:10.1016/j.juro.2008.09.025

« Previous Next »The Journal of Urology
Volume 181, Issue 1 , Pages 35-41, January 2009

Long-Term Outcomes After Nephron Sparing Surgery for Renal Cell Carcinoma Larger Than 4 cm

Matthieu Peycelon
- Department of Urology, Groupement Hospitalier Universitaire Est (Pitié-Tenon), Assistance-Publique Hôpitaux de Paris and Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
Vincent Hupertan
- Department of Urology, Groupement Hospitalier Universitaire Est (Pitié-Tenon), Assistance-Publique Hôpitaux de Paris and Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
Eva Comperat
- Department of Pathology, Groupement Hospitalier Universitaire Est (Pitié-Tenon), Assistance-Publique Hôpitaux de Paris and Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
Raphaële Renard-Penna
- Department of Radiology, Groupement Hospitalier Universitaire Est (Pitié-Tenon), Assistance-Publique Hôpitaux de Paris and Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
Christophe Vaessen
- Department of Urology, Groupement Hospitalier Universitaire Est (Pitié-Tenon), Assistance-Publique Hôpitaux de Paris and Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
Pierre Conort
- Department of Urology, Groupement Hospitalier Universitaire Est (Pitié-Tenon), Assistance-Publique Hôpitaux de Paris and Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
Marc-Olivier Bitker
- Department of Urology, Groupement Hospitalier Universitaire Est (Pitié-Tenon), Assistance-Publique Hôpitaux de Paris and Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
Emmanuel Chartier-Kastler
- Department of Urology, Groupement Hospitalier Universitaire Est (Pitié-Tenon), Assistance-Publique Hôpitaux de Paris and Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
François Richard
- Department of Urology, Groupement Hospitalier Universitaire Est (Pitié-Tenon), Assistance-Publique Hôpitaux de Paris and Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
Morgan Rouprêt
- Department of Urology, Groupement Hospitalier Universitaire Est (Pitié-Tenon), Assistance-Publique Hôpitaux de Paris and Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France
- Correspondence: Urology Department, Hospital Pitié, 47-83 Bvd. de l'Hopital, 75013 Paris, France

Received 12 May 2008 published online 13 November 2008.

Purpose

We determined the cancer control provided by nephron sparing surgery for renal cell carcinoma greater than 4 cm.

Materials and Methods

We performed a retrospective review of data on patients treated between 1980 and 2005. The case characteristics analyzed were patient age, surgical procedure, intraoperative parameters, complications, tumor size, Fuhrman grade, TNM stage, pathological data and outcome. Kaplan-Meier survival curves were generated.

Results

Median age of the 61 patients was 64 years (range 40 to 83). Mean ± SD intraoperative blood loss was 622 ml ± 691 (range 50 to 4,800) and mean operative time was 155.7 ± 82 minutes (range 52 to 360). Mean creatinine preoperatively and immediately postoperatively was 1.16 and 1.25 mg/dl, respectively. Mean renal cell carcinoma size was 56.3 ± 18 mm (range 41 to 100). Margin status was positive in 11 cases (18%). Median followup was 70.7 months. The 5 and 10-year cancer specific survival rate was 81% and 78%, respectively. The tumor-free survival rate was 92% at 5 years and 88% at 10 years. On univariate analysis tumor size more than 7 cm (p = 0.002), pathological stage (p = 0.001) and Fuhrman grade (p = 0.004) were associated with survival. On multivariate analysis only pathological stage and Fuhrman grade were significant (p <0.0001 and 0.007, respectively).

Conclusions

Our results support the fact that nephron sparing surgery is a useful and acceptable approach to renal cell carcinoma greater than 4 cm. When technically possible, nephron sparing surgery provides acceptable long-term cancer specific survival rates. However, oncological safety is less evident in cases of renal cell carcinoma greater than 7 cm. To date in such cases nephron sparing surgery should only be considered for absolute indications.

Key Words: kidney, carcinoma, renal cell, neoplasm recurrence, mortality

Abbreviations and Acronyms: NSS, nephron sparing surgery, RCC, renal cell carcinoma, RN, radical nephrectomy