HAMBURG, GERMANY (UroToday.com) - The authors from two German academic centers analyzed their database with regard to elective nephron-sparing surgery for tumors > 7 cm.
They found 91/5767 patients that were operated between 1984 and 2009. The complication rate was 29.6% and minor in 89.1% of them according to the Clavien classification. Median follow-up was 28 months (range 1-247 months). In 27% of cases the tumor was benign. Five and 10-year tumor-specific survival was 97% and 85%, respectively. Five- and 10-years overall survival was 88% and 64%, respectively. The authors concluded that elective nephron-sparing surgery is associated with complication rates and oncological outcomes comparable to those undergoing radical nephrectomy.
In this series, the number of patients with benign lesions was rather high raising the question of preoperative diagnostic imaging and – if in doubt – a preoperative biopsy of the tumor. Otherwise the data show that tumor size alone may not serve as a trigger for nephron-sparing surgery versus radical nephrectomy. Indeed, nephron-sparing surgery is limited more by technical rather than oncological aspects. Clearly, the application of nephron-sparing surgery must be increased – at least in patients with T1a and T1b tumors. Let us calculate our own rates of nephron-sparing surgery and discuss them…
Presented by M. Janssen et al. at the Deutsche Gesellschaft für Urologie (DGU) - 63rd Annual Congress - September 14 - 17, 2011 - Congress Center - Hamburg, Germany
Reported for UroToday by Christian Doehn, MD, PhD, Urologikum Lubeck, Lubeck, Germany.
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