OBJECTIVES: To compare oncological outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) for renal tumors ≤7 cm which preoperative imaging reveals potential renal sinus fat invasion (cT3a), as RN is preferred for these tumors due to concerns regarding high tumor stage.
MATERIALS AND METHODS: Among 1,137 nephrectomies performed for renal tumors ≤ 7 cm from January 2005 to August 2012, 401 solitary cT3a renal cell carcinomas (RCCs) without metastases were analyzed. Classification as cT3a included only renal sinus fat invasion, as there were no tumors with suspected perinephric fat invasion. Multivariate models were used to evaluate predictors of recurrence-free survival (RFS) and cancer-specific survival (CSS).
RESULTS: There were 34 RCCs (8.5%) with unexpected perinephric fat invasion, but only 77 RCCs (19.2%) were staged as pT3a. During the median follow-up of 43.0 months, recurrence occurred in seven (6.7%) PN cases and 25 (8.4%) RN cases. Six recurred PN cases had positive surgical margins (PSMs). The two cohorts showed equal oncologic outcomes with respect to 5-year RFS and CSS. Multivariate analyses revealed PSM, pathologic T stage, sarcomatoid dedifferentiation, and type of surgery as significant predictors of recurrence. Older age, pathologic T stage, and sarcomatoid dedifferentiation were significant predictors of cancer-specific mortality.
CONCLUSIONS: Renal tumors ≤ 7 cm with presumed renal sinus fat invasion were mostly pT1. PN conferred equivalent oncologic outcomes to RN. If clear surgical margins can be obtained, PN should be considered for these tumors, as patients may benefit from renal function preservation.
Written by:
Koo KC, Kim JC, Cho KS, Choi YD, Hong SJ, Yang SC, Ham WS. Are you the author?
Departments of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Reference: BJU Int. 2014 Aug 7. Epub ahead of print.
doi: 10.1111/bju.12893
PubMed Abstract
PMID: 25099267