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Erschienen in: Indian Journal of Surgical Oncology 2/2017

30.01.2017 | Review Article

Current Status of Nephron-Sparing Surgery (NSS) in the Management of Renal Tumours

verfasst von: Vivek Venkatramani, Sanjaya Swain, Ramgopal Satyanarayana, Dipen J. Parekh

Erschienen in: Indian Journal of Surgical Oncology | Ausgabe 2/2017

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Abstract

Nephron-sparing surgery has emerged as the surgical treatment of choice for small renal masses over the past two decades, replacing the traditional teaching of radical nephrectomy for renal cell carcinoma. With time, there has been an evolution in the techniques and indications for partial nephrectomy. This review summarizes the current status of nephron-sparing surgery for renal carcinoma and also deals with the future of this procedure.
Literatur
1.
Zurück zum Zitat Uzzo RG, Novick AC (2001) Nephron sparing surgery for renal tumors: indications, techniques and outcomes. J Urol 166(1):6–18PubMedCrossRef Uzzo RG, Novick AC (2001) Nephron sparing surgery for renal tumors: indications, techniques and outcomes. J Urol 166(1):6–18PubMedCrossRef
2.
Zurück zum Zitat Lam JS, Belldegrun AS, Pantuck AJ (2006) Long-term outcomes of the surgical management of renal cell carcinoma. World J Urol 24(3):255–266PubMedCrossRef Lam JS, Belldegrun AS, Pantuck AJ (2006) Long-term outcomes of the surgical management of renal cell carcinoma. World J Urol 24(3):255–266PubMedCrossRef
3.
Zurück zum Zitat Jemal A, Murray T, Ward E, Samuels A, Tiwari RC, Ghafoor A et al (2005) Cancer statistics, 2005. CA Cancer J Clin 55(1):10–30PubMedCrossRef Jemal A, Murray T, Ward E, Samuels A, Tiwari RC, Ghafoor A et al (2005) Cancer statistics, 2005. CA Cancer J Clin 55(1):10–30PubMedCrossRef
4.
5.
Zurück zum Zitat Russo P (2013) Oncological and renal medical importance of kidney-sparing surgery. Nat Rev Urol. 10(5):292–299PubMedCrossRef Russo P (2013) Oncological and renal medical importance of kidney-sparing surgery. Nat Rev Urol. 10(5):292–299PubMedCrossRef
6.
Zurück zum Zitat Licht MR, Novick AC (1993) Nephron sparing surgery for renal cell carcinoma. J Urol 149(1):1–7PubMedCrossRef Licht MR, Novick AC (1993) Nephron sparing surgery for renal cell carcinoma. J Urol 149(1):1–7PubMedCrossRef
7.
Zurück zum Zitat Russo P, Huang W (2008) The medical and oncological rationale for partial nephrectomy for the treatment of T1 renal cortical tumors. Urol Clin North Am. 35(4):635–643 viiPubMedCrossRef Russo P, Huang W (2008) The medical and oncological rationale for partial nephrectomy for the treatment of T1 renal cortical tumors. Urol Clin North Am. 35(4):635–643 viiPubMedCrossRef
8.
Zurück zum Zitat Thompson RH, Kurta JM, Kaag M, Tickoo SK, Kundu S, Katz D et al (2009) Tumor size is associated with malignant potential in renal cell carcinoma cases. J Urol 181(5):2033–2036PubMedPubMedCentralCrossRef Thompson RH, Kurta JM, Kaag M, Tickoo SK, Kundu S, Katz D et al (2009) Tumor size is associated with malignant potential in renal cell carcinoma cases. J Urol 181(5):2033–2036PubMedPubMedCentralCrossRef
9.
Zurück zum Zitat Nguyen MM, Gill IS (2009) Effect of renal cancer size on the prevalence of metastasis at diagnosis and mortality. J Urol 181(3):1020–1027 discussion 1027PubMedCrossRef Nguyen MM, Gill IS (2009) Effect of renal cancer size on the prevalence of metastasis at diagnosis and mortality. J Urol 181(3):1020–1027 discussion 1027PubMedCrossRef
10.
Zurück zum Zitat Fergany AF, Hafez KS, Novick AC (2000) Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10-year followup. J Urol 163(2):442–445PubMedCrossRef Fergany AF, Hafez KS, Novick AC (2000) Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10-year followup. J Urol 163(2):442–445PubMedCrossRef
11.
Zurück zum Zitat Timsit M-O, Bazin J-P, Thiounn N, Fontaine E, Chrétien Y, Dufour B et al (2006) Prospective study of safety margins in partial nephrectomy: intraoperative assessment and contribution of frozen section analysis. Urology 67(5):923–926PubMedCrossRef Timsit M-O, Bazin J-P, Thiounn N, Fontaine E, Chrétien Y, Dufour B et al (2006) Prospective study of safety margins in partial nephrectomy: intraoperative assessment and contribution of frozen section analysis. Urology 67(5):923–926PubMedCrossRef
12.
Zurück zum Zitat Yossepowitch O, Thompson RH, Leibovich BC, Eggener SE, Pettus JA, Kwon ED et al (2008) Positive surgical margins at partial nephrectomy: predictors and oncological outcomes. J Urol 179(6):2158–2163PubMedPubMedCentralCrossRef Yossepowitch O, Thompson RH, Leibovich BC, Eggener SE, Pettus JA, Kwon ED et al (2008) Positive surgical margins at partial nephrectomy: predictors and oncological outcomes. J Urol 179(6):2158–2163PubMedPubMedCentralCrossRef
13.
Zurück zum Zitat Van Poppel H, Becker F, Cadeddu JA, Gill IS, Janetschek G, Jewett MAS et al (2011) Treatment of localised renal cell carcinoma. Eur Urol 60(4):662–672PubMedCrossRef Van Poppel H, Becker F, Cadeddu JA, Gill IS, Janetschek G, Jewett MAS et al (2011) Treatment of localised renal cell carcinoma. Eur Urol 60(4):662–672PubMedCrossRef
14.
Zurück zum Zitat Kaplan C, Pasternack B, Shah H, Gallo G (1975) Age-related incidence of sclerotic glomeruli in human kidneys. Am J Pathol 80(2):227–234PubMedPubMedCentral Kaplan C, Pasternack B, Shah H, Gallo G (1975) Age-related incidence of sclerotic glomeruli in human kidneys. Am J Pathol 80(2):227–234PubMedPubMedCentral
15.
Zurück zum Zitat Bijol V, Mendez GP, Hurwitz S, Rennke HG, Nosé V (2006) Evaluation of the nonneoplastic pathology in tumor nephrectomy specimens: predicting the risk of progressive renal failure. Am J Surg Pathol 30(5):575–584PubMedCrossRef Bijol V, Mendez GP, Hurwitz S, Rennke HG, Nosé V (2006) Evaluation of the nonneoplastic pathology in tumor nephrectomy specimens: predicting the risk of progressive renal failure. Am J Surg Pathol 30(5):575–584PubMedCrossRef
16.
Zurück zum Zitat Huang WC, Levey AS, Serio AM, Snyder M, Vickers AJ, Raj GV et al (2006) Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol 7(9):735–740PubMedPubMedCentralCrossRef Huang WC, Levey AS, Serio AM, Snyder M, Vickers AJ, Raj GV et al (2006) Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol 7(9):735–740PubMedPubMedCentralCrossRef
17.
Zurück zum Zitat Lau WK, Blute ML, Weaver AL, Torres VE, Zincke H (2000) Matched comparison of radical nephrectomy vs nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin Proc 75(12):1236–1242PubMedCrossRef Lau WK, Blute ML, Weaver AL, Torres VE, Zincke H (2000) Matched comparison of radical nephrectomy vs nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin Proc 75(12):1236–1242PubMedCrossRef
18.
Zurück zum Zitat McKiernan J, Simmons R, Katz J, Russo P (2002) Natural history of chronic renal insufficiency after partial and radical nephrectomy. Urology 59(6):816–820PubMedCrossRef McKiernan J, Simmons R, Katz J, Russo P (2002) Natural history of chronic renal insufficiency after partial and radical nephrectomy. Urology 59(6):816–820PubMedCrossRef
19.
Zurück zum Zitat Thompson RH, Boorjian SA, Lohse CM, Leibovich BC, Kwon ED, Cheville JC et al (2008) Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy. J Urol 179(2):468–471 discussion 472–473PubMedCrossRef Thompson RH, Boorjian SA, Lohse CM, Leibovich BC, Kwon ED, Cheville JC et al (2008) Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy. J Urol 179(2):468–471 discussion 472–473PubMedCrossRef
20.
Zurück zum Zitat Pahernik S, Roos F, Röhrig B, Wiesner C, Thüroff JW (2008) Elective nephron sparing surgery for renal cell carcinoma larger than 4 cm. J Urol 179(1):71–74 discussion 74PubMedCrossRef Pahernik S, Roos F, Röhrig B, Wiesner C, Thüroff JW (2008) Elective nephron sparing surgery for renal cell carcinoma larger than 4 cm. J Urol 179(1):71–74 discussion 74PubMedCrossRef
21.
Zurück zum Zitat Thompson RH, Siddiqui S, Lohse CM, Leibovich BC, Russo P, Blute ML (2009) Partial versus radical nephrectomy for 4 to 7 cm renal cortical tumors. J Urol 182(6):2601–2606PubMedPubMedCentralCrossRef Thompson RH, Siddiqui S, Lohse CM, Leibovich BC, Russo P, Blute ML (2009) Partial versus radical nephrectomy for 4 to 7 cm renal cortical tumors. J Urol 182(6):2601–2606PubMedPubMedCentralCrossRef
22.
Zurück zum Zitat Volpe A, Amparore D, Mottrie A (2013) Treatment outcomes of partial nephrectomy for T1b tumours. Curr Opin Urol 23(5):403–410PubMedCrossRef Volpe A, Amparore D, Mottrie A (2013) Treatment outcomes of partial nephrectomy for T1b tumours. Curr Opin Urol 23(5):403–410PubMedCrossRef
23.
Zurück zum Zitat Touijer K, Jacqmin D, Kavoussi LR, Montorsi F, Patard JJ, Rogers CG et al (2010) The expanding role of partial nephrectomy: a critical analysis of indications, results, and complications. Eur Urol 57(2):214–222PubMedCrossRef Touijer K, Jacqmin D, Kavoussi LR, Montorsi F, Patard JJ, Rogers CG et al (2010) The expanding role of partial nephrectomy: a critical analysis of indications, results, and complications. Eur Urol 57(2):214–222PubMedCrossRef
24.
Zurück zum Zitat Hansen J, Sun M, Bianchi M, Rink M, Tian Z, Hanna N et al (2012) Assessment of cancer control outcomes in patients with high-risk renal cell carcinoma treated with partial nephrectomy. Urology 80(2):347–353PubMedCrossRef Hansen J, Sun M, Bianchi M, Rink M, Tian Z, Hanna N et al (2012) Assessment of cancer control outcomes in patients with high-risk renal cell carcinoma treated with partial nephrectomy. Urology 80(2):347–353PubMedCrossRef
25.
Zurück zum Zitat Lee HJ, Liss MA, Derweesh IH (2014) Outcomes of partial nephrectomy for clinical T1b and T2 renal tumors. Curr Opin Urol 24(5):448–452PubMedCrossRef Lee HJ, Liss MA, Derweesh IH (2014) Outcomes of partial nephrectomy for clinical T1b and T2 renal tumors. Curr Opin Urol 24(5):448–452PubMedCrossRef
26.
Zurück zum Zitat Kopp RP, Mehrazin R, Palazzi KL, Liss MA, Jabaji R, Mirheydar HS et al (2014) Survival outcomes after radical and partial nephrectomy for clinical T2 renal tumours categorised by R.E.N.A.L. nephrometry score. BJU Int 114(5):708–718PubMedCrossRef Kopp RP, Mehrazin R, Palazzi KL, Liss MA, Jabaji R, Mirheydar HS et al (2014) Survival outcomes after radical and partial nephrectomy for clinical T2 renal tumours categorised by R.E.N.A.L. nephrometry score. BJU Int 114(5):708–718PubMedCrossRef
27.
Zurück zum Zitat Bex A, Kroon BK, de Bruijn R (2012) Is there a role for neoadjuvant targeted therapy to downsize primary tumors for organ sparing strategies in renal cell carcinoma? Int J Surg Oncol 2012:250479PubMedPubMedCentral Bex A, Kroon BK, de Bruijn R (2012) Is there a role for neoadjuvant targeted therapy to downsize primary tumors for organ sparing strategies in renal cell carcinoma? Int J Surg Oncol 2012:250479PubMedPubMedCentral
28.
Zurück zum Zitat Cost NG, Krabbe L-M, Bagrodia A, Margulis V (2013) The use of preoperative targeted molecular therapy to allow nephron sparing for T1b tumors. Curr Opin Urol 23(5):411–417PubMedCrossRef Cost NG, Krabbe L-M, Bagrodia A, Margulis V (2013) The use of preoperative targeted molecular therapy to allow nephron sparing for T1b tumors. Curr Opin Urol 23(5):411–417PubMedCrossRef
29.
Zurück zum Zitat Shahait M, Mukherji D, El-Hout Y (2015) Partial nephrectomy for metastatic renal cell carcinoma: where do we stand? Indian J Urol IJU J Urol Soc India 31(2):102–105CrossRef Shahait M, Mukherji D, El-Hout Y (2015) Partial nephrectomy for metastatic renal cell carcinoma: where do we stand? Indian J Urol IJU J Urol Soc India 31(2):102–105CrossRef
30.
Zurück zum Zitat Rini BI, Plimack ER, Takagi T, Elson P, Wood LS, Dreicer R et al (2015) A phase II study of pazopanib in patients with localized renal cell carcinoma to optimize preservation of renal parenchyma. J Urol 194(2):297–303PubMedCrossRef Rini BI, Plimack ER, Takagi T, Elson P, Wood LS, Dreicer R et al (2015) A phase II study of pazopanib in patients with localized renal cell carcinoma to optimize preservation of renal parenchyma. J Urol 194(2):297–303PubMedCrossRef
31.
Zurück zum Zitat Buethe DD, Spiess PE (2013) Current management considerations for the incidentally detected small renal mass. Cancer Control J Moffitt Cancer Cent 20(3):211–221 Buethe DD, Spiess PE (2013) Current management considerations for the incidentally detected small renal mass. Cancer Control J Moffitt Cancer Cent 20(3):211–221
32.
Zurück zum Zitat Waldert M, Klatte T (2014) Nephrometry scoring systems for surgical decision-making in nephron-sparing surgery. Curr Opin Urol 24(5):437–440PubMedCrossRef Waldert M, Klatte T (2014) Nephrometry scoring systems for surgical decision-making in nephron-sparing surgery. Curr Opin Urol 24(5):437–440PubMedCrossRef
33.
Zurück zum Zitat Kutikov A, Uzzo RG (2009) The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182(3):844–853PubMedCrossRef Kutikov A, Uzzo RG (2009) The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182(3):844–853PubMedCrossRef
34.
Zurück zum Zitat Russo P (2010) Partial nephrectomy for renal cancer (part II): the impact of renal ischaemia, patient preparation, surgical approaches, management of complications and utilization. BJU Int 105(11):1494–1507PubMedCrossRef Russo P (2010) Partial nephrectomy for renal cancer (part II): the impact of renal ischaemia, patient preparation, surgical approaches, management of complications and utilization. BJU Int 105(11):1494–1507PubMedCrossRef
35.
Zurück zum Zitat Parekh DJ, Weinberg JM, Ercole B, Torkko KC, Hilton W, Bennett M et al (2013) Tolerance of the human kidney to isolated controlled ischemia. J Am Soc Nephrol JASN 24(3):506–517PubMedCrossRef Parekh DJ, Weinberg JM, Ercole B, Torkko KC, Hilton W, Bennett M et al (2013) Tolerance of the human kidney to isolated controlled ischemia. J Am Soc Nephrol JASN 24(3):506–517PubMedCrossRef
36.
Zurück zum Zitat Wszolek MF, Kenney PA, Libertino JA (2011) Nonclamping partial nephrectomy: towards improved nephron sparing. Nat Rev Urol. 8(9):523–527PubMedCrossRef Wszolek MF, Kenney PA, Libertino JA (2011) Nonclamping partial nephrectomy: towards improved nephron sparing. Nat Rev Urol. 8(9):523–527PubMedCrossRef
37.
Zurück zum Zitat Kallingal GJS, Weinberg JM, Reis IM, Nehra A, Venkatachalam MA, Parekh DJ (2015) Long-term response to renal ischaemia in the human kidney after partial nephrectomy: results from a prospective clinical trial. BJU Int Kallingal GJS, Weinberg JM, Reis IM, Nehra A, Venkatachalam MA, Parekh DJ (2015) Long-term response to renal ischaemia in the human kidney after partial nephrectomy: results from a prospective clinical trial. BJU Int
38.
Zurück zum Zitat Hung AJ, Tsai S, Gill IS (2013) Does eliminating global renal ischemia during partial nephrectomy improve functional outcomes? Curr Opin Urol 23(2):112–117PubMedCrossRef Hung AJ, Tsai S, Gill IS (2013) Does eliminating global renal ischemia during partial nephrectomy improve functional outcomes? Curr Opin Urol 23(2):112–117PubMedCrossRef
39.
40.
Zurück zum Zitat Eisenberg MS, Patil MB, Thangathurai D, Gill IS (2011) Innovations in laparoscopic and robotic partial nephrectomy: a novel “zero ischemia” technique. Curr Opin Urol 21(2):93–98PubMedCrossRef Eisenberg MS, Patil MB, Thangathurai D, Gill IS (2011) Innovations in laparoscopic and robotic partial nephrectomy: a novel “zero ischemia” technique. Curr Opin Urol 21(2):93–98PubMedCrossRef
41.
Zurück zum Zitat Simone G, Ferriero M, Papalia R, Costantini M, Guaglianone S, Gallucci M (2013) Zero-ischemia minimally invasive partial nephrectomy. Curr Urol Rep 14(5):465–470PubMedCrossRef Simone G, Ferriero M, Papalia R, Costantini M, Guaglianone S, Gallucci M (2013) Zero-ischemia minimally invasive partial nephrectomy. Curr Urol Rep 14(5):465–470PubMedCrossRef
42.
Zurück zum Zitat Autorino R, Zargar H, White WM, Novara G, Annino F, Perdonà S et al (2014) Current applications of near-infrared fluorescence imaging in robotic urologic surgery: a systematic review and critical analysis of the literature. Urology 84(4):751–759PubMedCrossRef Autorino R, Zargar H, White WM, Novara G, Annino F, Perdonà S et al (2014) Current applications of near-infrared fluorescence imaging in robotic urologic surgery: a systematic review and critical analysis of the literature. Urology 84(4):751–759PubMedCrossRef
43.
Zurück zum Zitat Krane LS, Hemal AK (2014) Emerging technologies to improve techniques and outcomes of robotic partial nephrectomy: striving toward the pentafecta. Urol Clin North Am. 41(4):511–519PubMedCrossRef Krane LS, Hemal AK (2014) Emerging technologies to improve techniques and outcomes of robotic partial nephrectomy: striving toward the pentafecta. Urol Clin North Am. 41(4):511–519PubMedCrossRef
44.
Zurück zum Zitat Leslie S, Goh AC, Gill IS (2013) Partial nephrectomy—contemporary indications, techniques and outcomes. Nat Rev Urol 10(5):275–283PubMedCrossRef Leslie S, Goh AC, Gill IS (2013) Partial nephrectomy—contemporary indications, techniques and outcomes. Nat Rev Urol 10(5):275–283PubMedCrossRef
45.
Zurück zum Zitat Ficarra V, Rossanese M, Gnech M, Novara G, Mottrie A (2014) Outcomes and limitations of laparoscopic and robotic partial nephrectomy. Curr Opin Urol 24(5):441–447PubMedCrossRef Ficarra V, Rossanese M, Gnech M, Novara G, Mottrie A (2014) Outcomes and limitations of laparoscopic and robotic partial nephrectomy. Curr Opin Urol 24(5):441–447PubMedCrossRef
46.
Zurück zum Zitat Rogers C, Sukumar S, Gill IS (2011) Robotic partial nephrectomy: the real benefit. Curr Opin Urol 21(1):60–64PubMedCrossRef Rogers C, Sukumar S, Gill IS (2011) Robotic partial nephrectomy: the real benefit. Curr Opin Urol 21(1):60–64PubMedCrossRef
47.
Zurück zum Zitat Sivarajan G, Huang WC (2012) Current practice patterns in the surgical management of renal cancer in the United States. Urol Clin North Am 39(2):149–160 vPubMedCrossRef Sivarajan G, Huang WC (2012) Current practice patterns in the surgical management of renal cancer in the United States. Urol Clin North Am 39(2):149–160 vPubMedCrossRef
Metadaten
Titel
Current Status of Nephron-Sparing Surgery (NSS) in the Management of Renal Tumours
verfasst von
Vivek Venkatramani
Sanjaya Swain
Ramgopal Satyanarayana
Dipen J. Parekh
Publikationsdatum
30.01.2017
Verlag
Springer India
Erschienen in
Indian Journal of Surgical Oncology / Ausgabe 2/2017
Print ISSN: 0975-7651
Elektronische ISSN: 0976-6952
DOI
https://doi.org/10.1007/s13193-016-0587-0

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