OBJECTIVES: To analyze to what extent partial nephrectomy (PN) is superior to radical nephrectomy (RN) in preserving renal function outcome in relation to tumor size indication.
METHODS AND MATERIALS: Clinical data from 973 patients operated at 9 academic institutions were retrospectively analyzed. Glomerular filtration rate (GFR) before and after surgery was calculated with the abbreviated Modification of the Diet in Renal Disease equation. For a fair comparison between the 2 techniques, all imperative indications for PN were excluded. A shift to a less favorable GFR group following surgery was considered clinically significant.
RESULTS: Median age at diagnosis was 60 years (19-91). Tumor size was smaller than 4cm in 665 (68.3%) cases and larger than 4cm in 308 (31.7%) cases. PN and RN were performed in 663 (68.1%) and 310 (31.9%) patients, respectively. In univariate analysis, patients undergoing PN had a smaller risk for developing significant GFR change following surgery than those undergoing RN did. This was true for tumors≤ 4cm (P = 0.0001) and for tumors >4cm (P = 0.0001). In multivariate analysis, the following criteria were independent predictive factors for developing significant postoperative GFR loss: the use of RN (P = 0.0001), preoperative GFR< 60ml/min (P = 0.0001), tumor size ≥4cm (P = 0.0001), and older age at diagnosis (P = 0.0001).
CONCLUSIONS: The renal function benefit carried out by elective PN over RN persists even when expanding nephron-sparing surgery indications beyond the traditional 4-cm cutoff.
Written by:
Pignot G, Bigot P, Bernhard JC, Bouliere F, Bessede T, Bensalah K, Salomon L, Mottet N, Bellec L, Soulié M, Ferrière JM, Pfister C, Drai J, Colombel M, Villers A, Rigaud J, Bouchot O, Montorsi F, Bertini R, Belldegrun AS, Pantuck AJ, Patard JJ. Are you the author?
Department of Urology, Bicetre Hospital, Paris XI University, Le Kremlin Bicêtre, France; Department of Urology, Angers University Hospital, Angers, France; Department of Urology, Pellegrin Hospital, Bordeaux University, Bordeaux, France; Department of Urology, Bicetre Hospital, Paris XI University, Le Kremlin Bicêtre, France; Department of Urology, Pontchaillou Hospital, Rennes University, Rennes, France; Department of Urology, Henri Mondor Hospital, Paris XII University, Créteil, France; Department of Urology, Saint-Etienne University Hospital, Saint-Etienne, France; Department of Urology, Rangueil Hospital, Toulouse University, Toulouse, France; Department of Urology, Rouen University Hospital, Rouen, France; Department of Urology, Edouard Herriot Hospital, Lyon University, Lyon, France; Department of Urology, Huriez Hospital, Lille Nord de France University, Lille, France; Department of Urology, Hôtel Dieu Hospital, Nantes University, Nantes, France; Department of Urology, Vita-Salute University San Raffaele, Milan, Italy; Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA.
Reference: Urol Oncol. 2014 Jul 1. pii: S1078-1439(14)00098-2.
doi: 10.1016/j.urolonc.2014.03.012
PubMed Abstract
PMID: 24996775
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