Adult urologyPartial nephrectomy and radical nephrectomy offer similar cancer outcomes in renal cortical tumors 4 cm or larger
Section snippets
Material and methods
The Columbia University Comprehensive Urologic Oncology Database (approved by Columbia’s institutional review board) was reviewed, and 830 patients were identified who had undergone renal surgery for presumed RCTs from 1988 to 2004. Of these, 256 (30.1%) had undergone PN. From this cohort, 71 (8.6% of all nephrectomy patients) were identified who had undergone PN for tumors 4 cm or greater. Patients with lymph node metastases, distant metastatic disease, prior renal surgery, genetic syndromes,
Results
The clinicopathologic data are displayed in Table I. No significant differences were found between the PN and RN groups on the basis of age, sex, histologic subtype, tumor diameter, or grade. At analysis, 28 patients (84.8%) in the PN group had no evidence of disease progression versus 52 (78.8%) in the RN group. Additionally, 1 patient (3.0%) in the PN group was alive with disease versus 8 (12.1%) in the RN group; 1 patient (3.0%) in the PN group had died of the disease versus 3 (4.5%) in the
Comment
Although it is established that PN can provide cancer control rates similar to RN for tumors 4 cm or less, the particular subset of patients to whom PN should be offered remains controversial.8 In 1993, Licht and Novick9 wrote that the indications for PN should be limited to situations in which RN would render a patient anephric and situations in which the function of the opposite kidney would be likely to be compromised in the future. As long-term follow-up data became available, however, the
Conclusions
The results of this study found that cancer outcomes after PN do not differ from the outcomes after RN for tumors of 4 cm or greater. The widely accepted upper limit of 4 cm appears to have been determined rather arbitrarily from studies that did not compare PN results with RN results. In light of this evidence, as well as data from Patard et al.6 and Leibovitch et al.,5 it is no longer advisable to restrict nephron-sparing surgery to patients with tumors smaller than 4 cm in diameter.
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