Nephron-sparing surgery is superior to radical nephrectomy in preserving renal function benefit even when expanding indications beyond the traditional 4-cm cutoff

Géraldine Pignot, Pierre Bigot, Jean Christophe Bernhard, Fabien Bouliere, Thomas Bessede, Karim Bensalah, Laurent Salomon, Nicolas Mottet, Laurent Bellec, Michel Soulié, Jean Marie Ferrière, Christian Pfister, Julien Drai, Marc Colombel, Arnauld Villers, Jerome Rigaud, Olivier Bouchot, Francesco Montorsi, Roberto Bertini, Arie S. BelldegrunAllan J. Pantuck, Jean Jacques Patard

Research output: Contribution to journalArticlepeer-review

Abstract

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 4. cm in 665 (68.3%) cases and larger than 4. cm 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≤4. cm (P = 0.0001) and for tumors>4. cm (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

Original languageEnglish
Pages (from-to)1024-1030
Number of pages7
JournalUrologic Oncology: Seminars and Original Investigations
Volume32
Issue number7
DOIs
Publication statusPublished - Oct 1 2014

Keywords

  • Chronic renal disease
  • Glomerular filtration rate
  • Partial nephrectomy
  • Renal cell carcinoma
  • Renal function
  • Survival

ASJC Scopus subject areas

  • Oncology
  • Urology
  • Medicine(all)

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