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.
Written by:
Bigot P, Hétet JF, Bernhard JC, Fardoun T, Audenet F, Xylinas E, Ploussard G, Pignot G, Bessede T, Ouzaid I, Robine E, Brureau L, Merigot de Treigny O, Maurin C, Long JA, Rouffilange J, Hoarau N, Lebdai S, Rouprêt M, Bastien L, Neuzillet Y, Mongiat-Artus P, Verhoest G, Zerbib M, Ravery V, Rigaud J, Bellec L, Baumert H, Chautard D, Bensalah K, Escudier B, Paparel P, Grenier N, Rioux-Leclercq N, Azzouzi AR, Soulié M, Patard JJ. Are you the author?
Cancerology Committee of the French Association of Urology (CCAFU), Paris, France; Department of Urology, Angers University Hospital, Angers, France.
Reference: Clin Genitourin Cancer. 2013 Sep 28. pii: S1558-7673(13)00215-2.
doi: 10.1016/j.clgc.2013.09.004
PubMed Abstract
PMID: 24210610
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