Comparative analysis of results of radical nephrectomy and partial nephrectomy for clinically localized renal cell carcinoma in patients with normal functioning contralateral kidney


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Abstract

The study was aimed to the evaluation of the safety and feasibility of partial nephrectomy for clinically localized renal cell carcinoma in patients with a normally functioning contralateral kidney. A comparative analysis of the results of radical nephrectomy (n = 226) and partial nephrectomy (n = 227) in patients with cT1 -2N0M0 renal cancer with normally functioning contralateral kidney was performed. Groups of patients subjected to different extent of operations were matched by sex, age, side of lesion, baseline characteristics of the tumor, and renal function (P> 0.05 for all); pT1a category and degree G1of anaplasia were more often diagnosed in the partial nephrectomy group (P < 0.0001). None of the 453 patients has received additional treatment. Median follow-up period was 50 (12-224) months. It was found that partial nephrectomy is associated with a significant increase in the duration of surgery (P = 0.031), blood loss volume (P <0.000), and the risk of complications (OR = 2.8 (95% CI: 1.64.7); P < 0.0001) compared with radical nephrectomy. Complications of partial nephrectomy do not increase the risk of decline in renal function and death. Partial nephrectomy is comparable to radical nephrectomy in terms of recurrence free survival (HR = 5.9 ( 95 % CI: 0.9-38.3)), specific survival (HR = 0.1 ( 95% CI : 0-12555.9 )) cardiospecific survival (HR = 1.1 ( 95 % CI: 0.3-4.6)), and overall survival (HR = 0.8 ( 95 % CI: 0.2-2.5)), including stratification of patients by demographic characteristics, characteristics of the tumor and postoperative renal function (P> 0.05 for all). Nephrectomy increases the risk of acute renal dysfunction by 1.8 times and reduces the risk of developing stage ≥ 3 chronic kidney disease in the late postoperative period by 1.4 times compared with radical nephrectomy. The effects of extent of operations on the quality of life were not revealed. Thus, the use of partial nephrectomy allows to improve the longterm functional results of surgical treatment for clinically localized renal cell carcinoma, and is associated with an increased incidence of complications that do not lead, however, to a decrease in survival compared with radical nephrectomy. The choice of method of surgical treatment of such patients should be individualized.

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About the authors

M. I Volkova

FSBI “RORC n.a. N.N. Blokhin RAMS”

Email: mivolkova@rambler.ru
Senior Scientist at the Department of Urology

I. Ya Skvortsov

FSBI “RORC n.a. N.N. Blokhin RAMS”

A. V Klimov

FSBI “RORC n.a. N.N. Blokhin RAMS”

V. A Chernyaev

FSBI “RORC n.a. N.N. Blokhin RAMS”

S. A Kalinin

FSBI “RORC n.a. N.N. Blokhin RAMS”

M. V Peters

FSBI “RORC n.a. N.N. Blokhin RAMS”

V. B Matveev

FSBI “RORC n.a. N.N. Blokhin RAMS”

References

  1. Campbell S.C., Novick A.C., Belldegrun A. et al. Guideline for management of the clinical T1 renal mass. J Urol. 2009; 182: 1271.
  2. Ljungberg B., Cowan N.C., Hanbury D.C. et al. EAU guidelines on renal cell carcinoma: the 2010 update. Eur. Urol. 2010; 58: 398.
  3. Motzer R.J., Agarwal N., Beard C. et al. NCCN clinical practice guidelines in oncology: kidney сancer. J Natl. Cancer Netw. 2009; 7: 618.
  4. Huang W.C., Elkin E.B., Levey A.S. et al. Partial nephrectomy versus radical nephrectomy in patients with small renal tumors - is there a difference in mortality and cardiovascular outcomes? J Urol. 2009; 181: 55.
  5. Miller D.C., Schonlau M., Litwin M.S. et al. Urologic Diseases in America Project. Renal and cardiovascular morbidity after partial or radical nephrectomy. Cancer. 2008; 112(3): 511-520.
  6. Thompson R.H., Siddiqui S., Lohse C.M. et al. Partial versus radical nephrectomy for 4 to 7 cm renal cortical tumors. J Urol. 2009; 182: 2601.
  7. Weight C.J., Lieser G., Larson B.T. et al. Partial nephrectomy is associated with improved overall survival compared to radical nephrectomy in patients with unanticipated benign renal tumours. Eur. Urol. 2010; 58: 293-298.
  8. Van Poppel H., Da Pozzo L., Albrecht W. et al. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol. 2011; 59: 543-552.
  9. KDOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002; 39: S1-266.
  10. Bellomo R., Ronco C., Kellum J.A. et al. Acute renal failure -definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004; 8(4): R204-212.
  11. Lowrance W.T., Yee D.S., Savage C. et al. Complications after radical and partial nephrectomy as a function of age. J Urol. 2010; 183(5): 1725-1730.
  12. Corman J.M., Penson D.F., Hur K. et al. Comparison of complications after radical and partial nephrectomy: results from the National Veterans Administration Surgical Quality Improvement Program. BJU Int. 2000; 86(7): 782-789.
  13. Van Poppel H., Da Pozzo L., Albrecht W. et al. A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur. Urol. 2007; 51: 1606-1615.
  14. Kim Simon P., Thompson R.H., Boorjian S.A. et al. Comparative Effectiveness for Survival and Renal Function of Partial and Radical Nephrectomy for Localized Renal Tumors: A Systematic Review and Meta-Analysis. J Urol. 2012; 188: 51-57.
  15. Shlipak M.G., Smith G.L., Rathore S.S. et al. Renal function, digoxin therapy, and heart failure outcomes: Evidence from the digoxin intervention group trial. J Am. Soc. Nephrol. 2004; 15: 2195-2203.
  16. Knight S., Johns E.J. Renal functional responses to ischaemia-reperfusion injury in normotensive and hypertensive rats following non-selective and selective cyclo-oxygenase inhibition with nitric oxide donation. Clin. Exper. Pharmacol. Physiol. 2008; 35(1): 11-16.
  17. Brenner B.M. Nephron adaptation to renal injury of ablation. Am. J Physiol. 1985; 249: 324-337.
  18. Indudhara R., Bueschen A.J., Urban D.A. et al. Nephron-sparing surgery compared with radical nephrectomy for renal tumors: current indications and results. South Med J 1997; 90: 982.
  19. McKiernan J., Simmons R., Katz J., Russo P. Natural history of chronic renal insufficiency after partial and radical nephrectomy. Urology 2002; 59: 816-820.
  20. Lau W.K., Blute M.L., Weaver A.L. et al. Matched comparison of radical nephrectomy vs nephron sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin. Proc. 2000; 75: 1236-1242.
  21. Clark P.E., Schover L.R., Uzzo R.G. et al. Quality of life and psychological adaptation after surgical treatment for localized renal cell carcinoma: impact of the amount of remaining renal tissue. Urology. 2001; 57: 252-256.
  22. Poulakis V., Witzsch U., De Vries R. et al. Quality of life after surgery for localized renal cell carcinoma: comparison between radical nephrectomy and nephron sparing surgery. Urology. 2003; 62: 814-820.
  23. Shinohara N., Harabayashi T., Sato S. et al. Impact of nephronsparing surgery on quality of life in patients with localized renal cell carcinoma. Eur. Urol. 2001; 39: 114-119.
  24. Ficarra V., Novella G., Sarti A. et al. Psycho-social well-being and general health status after surgical treatment for localized renal cell carcinoma. Int. Urol. Nephrol. 2002-2003; 34: 441-446.

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