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96 Partial nephrectomy for renal tumors of more than 7 cm: Oncological, morbidity and renal function outcomes
96
Partial nephrectomy for renal tumors of more than 7 cm: Oncological, morbidity and renal function outcomes Eur Urol Suppl 2013;12;e96
Rouffilange J., Donon L., Capon G., Vergnolles M., Renard O., Ferretti L., Robert G., Pasticier G., Ballanger P., Ferrière JM., Bernhard J-C. University Hospital of Bordeaux, Dept. of Urology, Bordeaux, France INTRODUCTION & OBJECTIVES: Both the European Association of Urology and the French Association of Urology, recomend an extension of the indications of Partial Nephrectomy (PN) within the limits of technical feasibility. We wanted to assess the morbidity, mortality, oncological and functional results of PN for the treatment of renal tumors greater than 7cm. MATERIAL & METHODS: We retrospectively analyzed PN cases for tumors greater than 7cm performed in our centre, between 1987 and 2012. The evaluation criteria were related to surgical technique, tumor type, anatomical features, intraoperative and postoperative complications. Change in renal function was monitored using the MDRD formula at postoperative day 5, at 1 month and at last follow-up. We also assessed locoregional and metastatic recurrences, cancer specific and overall mortality. All data were collected in our Kidney Cancer Database UroCCR. RESULTS: Of a 466 total number of PN performed in our center during the study period, 29 patients met the criteria for inclusion into the study. The average age was 53.24 years (+/-17.9). The mean ASA score and the Charlson Comorbidity Index were 2 (1-3) and 4 (1-8) respectively. The indication for surgery was imperative in 12 (41.4%) patients. The average tumor size was 9.2 cm (+/-2.8). The GFR according to the mean preoperative MDRD was 79.9 ml/mn (+/-19.9). The mean operative time was 135min (+/-61). In 28 (96.5%) patients, vascular clamping was performed during an average time of 22.6 min (+/- 11.9). There were 4 surgical (13.8%) and 5 medical (17.2%) complications. GFR at day 5, at 1 month, and at last follow-up were 67.2 ml/mn (+/-30.2), 77.33 ml/mn (+/-22.5) and 78.1 ml/mn (+/-22.6) respectively. Malignant tumors accounted for 58.6% of the cases (n=17): 11 clear cell, 5 papillary and 1 chromophobe carcinomas. High Fuhrman grade (3 or 4) was found in 11 patients (64.7%). We had no positive surgical margin. With a mean follow-up of 32 months (2-150), 4 patients (23.5%) experienced local recurrence, 4 (23.5%) had metastatic progression and 3 (17.6%) died from cancer. CONCLUSIONS: This mono-centric series confirms the feasibility of PN for tumors over 7cm but a global complication rate of 31% has to be kept in mind. Functional outcome was excellent considering that mean GFR returned to near baseline level as soon as 1 month postoperative. Long term oncological results, need to be confirmed by longer follow-up. However, although we had no positive margin, we experienced a high local recurrence rate (23.5%).
Partial nephrectomy for renal tumors of more than 7 cm: Oncological, morbidity and renal function outcomes Eur Urol Suppl 2013;12;e96
Rouffilange J., Donon L., Capon G., Vergnolles M., Renard O., Ferretti L., Robert G., Pasticier G., Ballanger P., Ferrière JM., Bernhard J-C. University Hospital of Bordeaux, Dept. of Urology, Bordeaux, France INTRODUCTION & OBJECTIVES: Both the European Association of Urology and the French Association of Urology, recomend an extension of the indications of Partial Nephrectomy (PN) within the limits of technical feasibility. We wanted to assess the morbidity, mortality, oncological and functional results of PN for the treatment of renal tumors greater than 7cm. MATERIAL & METHODS: We retrospectively analyzed PN cases for tumors greater than 7cm performed in our centre, between 1987 and 2012. The evaluation criteria were related to surgical technique, tumor type, anatomical features, intraoperative and postoperative complications. Change in renal function was monitored using the MDRD formula at postoperative day 5, at 1 month and at last follow-up. We also assessed locoregional and metastatic recurrences, cancer specific and overall mortality. All data were collected in our Kidney Cancer Database UroCCR. RESULTS: Of a 466 total number of PN performed in our center during the study period, 29 patients met the criteria for inclusion into the study. The average age was 53.24 years (+/-17.9). The mean ASA score and the Charlson Comorbidity Index were 2 (1-3) and 4 (1-8) respectively. The indication for surgery was imperative in 12 (41.4%) patients. The average tumor size was 9.2 cm (+/-2.8). The GFR according to the mean preoperative MDRD was 79.9 ml/mn (+/-19.9). The mean operative time was 135min (+/-61). In 28 (96.5%) patients, vascular clamping was performed during an average time of 22.6 min (+/- 11.9). There were 4 surgical (13.8%) and 5 medical (17.2%) complications. GFR at day 5, at 1 month, and at last follow-up were 67.2 ml/mn (+/-30.2), 77.33 ml/mn (+/-22.5) and 78.1 ml/mn (+/-22.6) respectively. Malignant tumors accounted for 58.6% of the cases (n=17): 11 clear cell, 5 papillary and 1 chromophobe carcinomas. High Fuhrman grade (3 or 4) was found in 11 patients (64.7%). We had no positive surgical margin. With a mean follow-up of 32 months (2-150), 4 patients (23.5%) experienced local recurrence, 4 (23.5%) had metastatic progression and 3 (17.6%) died from cancer. CONCLUSIONS: This mono-centric series confirms the feasibility of PN for tumors over 7cm but a global complication rate of 31% has to be kept in mind. Functional outcome was excellent considering that mean GFR returned to near baseline level as soon as 1 month postoperative. Long term oncological results, need to be confirmed by longer follow-up. However, although we had no positive margin, we experienced a high local recurrence rate (23.5%).