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Simple Enucleation Versus Radical Nephrectomy in the Treatment of pT1a and pT1b Renal Cell Carcinoma

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Simple tumor enucleation (TE) showed excellent oncologic results in large retrospective series. No study has compared oncologic outcomes after TE and radical nephrectomy (RN) for the treatment of pT1 renal cell carcinoma (RCC). The aim of the present study is to compare the oncologic outcomes after TE and RN in pT1 RCCs.

Methods

We retrospectively analyzed 475 patients who underwent TE or RN for pT1 RCC, N0, M0, between 1995 and 2007. TE was performed in 332 patients and RN in 143. Local recurrence, progression-free survival (PFS), and cancer-specific survival (CSS) were the main outcomes of this study. The Kaplan-Meier method was used to calculate survival functions, and differences were assessed with the log rank statistic. Univariate and multivariate Cox regression models were also used.

Results

The 5- and 10-year PFS estimates were 91.3 and 88.7% after RN and 95.3 and 92.8% after TE (P = NS), respectively. The 5- and 10-year CSS estimates were 92.1 and 89.4% after RN and 94.4% (5- and 10-year CSS) after TE (P = NS), respectively. No statistically significant differences between RN and TE were found after adjusting CSS probabilities according to age at surgery, grade, stage, or clear cell subtype. Surgical treatment was not a predictor of PFS or CSS by both univariate and multivariate analyses. The potential limitation of this study is that the data originate from a retrospective review.

Conclusions

TE can achieve oncologic results similar to those of RN for the treatment of pT1 RCCs, provided tumors are carefully selected on the basis of their safe and complete removal.

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References

  1. Uzzo RG, Novick AC. Nephron sparing surgery for renal tumors: indications, techniques and outcomes. J Urol. 2001;166:6–18.

    Article  PubMed  CAS  Google Scholar 

  2. Fergany AF, Hafez KS, Novick AC. Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10-year follow up. J Urol. 2000;163:442–5.

    Article  PubMed  CAS  Google Scholar 

  3. Leibovich BC, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H. Nephron sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm results in outcome similar to radical nephrectomy. J Urol. 2004;171:1066.

    Article  PubMed  Google Scholar 

  4. Patard JJ, Shvarts O, Lam JS, et al. Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience. J Urol. 2004;171:2181–5.

    Article  PubMed  Google Scholar 

  5. Becker F, Siemer S, Hack M, Humke U, Ziegler M, Stöckle M. Excellent long-term cancer control with elective nephron-sparing surgery for selected renal cell carcinomas measuring more than 4 cm. Eur Urol. 2006;49:1058–63.

    Article  PubMed  Google Scholar 

  6. Antonelli A, Cozzoli A, Nicolai M, et al. Nephron-sparing surgery versus radical nephrectomy in the treatment of intracapsular renal cell carcinoma up to 7 cm. Eur Urol. 2008;53:803–9.

    Article  PubMed  Google Scholar 

  7. Ljungberg B, Cowan N, Hanbury DC, et al. Guidelines on renal cell carcinoma. European Association of Urology Guidelines. 2010 Edition.

    Google Scholar 

  8. Touijer K, Jacqmin D, Kavoussi LR, et al. The expanding role of partial nephrectomy: a critical analysis of indications, results, and complications. Eur Urol. 2010;57:214–22.

    Article  PubMed  Google Scholar 

  9. Li QL, Guan HW, Zhang QP, Zhang LZ, Wang FP, Liu YJ. Optimal margin in nephron-sparing surgery for renal cell carcinoma 4 cm or less. Eur Urol. 2003;44:448–51.

    Article  Google Scholar 

  10. Castilla EA, Liou LS, Abrahams NA, et al. Prognostic importance of resection margin width after nephron-sparing surgery for renal cell carcinoma. Urology. 2002;60:993–7.

    Article  PubMed  Google Scholar 

  11. Carini M, Minervini A, Masieri L, Lapini A, Serni S. Simple enucleation for the treatment of pT1a renal cell carcinoma: our 20-year experience. Eur Urol. 2006;50:1263–71.

    Article  PubMed  Google Scholar 

  12. Carini M, Minervini A, Lapini A, Masieri L, Serni S. Simple enucleation for the treatment of renal cell carcinoma between 4 and 7 cm in greatest dimension: progression and long-term survival. J Urol. 2006;175:2022–6.

    Article  PubMed  Google Scholar 

  13. Kutikov A, Vanarsdalen KN, Gershman B, et al. Enucleation of renal cell carcinoma with ablation of the tumour base. BJU Int. 2008;102:688–91.

    Article  PubMed  Google Scholar 

  14. Minervini A, Serni S, Tuccio A, et al. Local recurrence after tumour enucleation for renal cell carcinoma with no ablation of the tumour bed: results of a prospective single-centre study. BJU Int. 2011;107:1394–9.

    Article  PubMed  Google Scholar 

  15. Oken MM, Creech RH, Tormey DC, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5:649–55.

    Article  PubMed  CAS  Google Scholar 

  16. Greene FL, Page DL, Fleming ID, et al. American Joint Committee on Cancer (AJCC) Staging Manual, 6th ed. Philadelphia: Springer; 2002.

    Google Scholar 

  17. Kovacs G, Akhtar M, Beckwith BJ, et al. The Heidelberg classification of renal cell tumors. J Pathol. 1997;183:131–3.

    Article  PubMed  CAS  Google Scholar 

  18. Fuhrman S, Lasky LC, Limas L. Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol. 1982;6:655–63.

    Article  PubMed  CAS  Google Scholar 

  19. Huang WC, Levey AS, Serio AM, et al. Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol. 2006;7:735–40.

    Article  PubMed  Google Scholar 

  20. Huang WC, Elkin EB, Levey AS, Jang TL, Russo P. Partial nephrectomy versus radical nephrectomy in patients with small renal tumors-Is there a difference in mortality and cardiovascular outcomes? J Urol. 2009;181:55–62.

    Article  PubMed  Google Scholar 

  21. 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;59:543–52.

    Article  PubMed  Google Scholar 

  22. Van Poppel H, Joniau S. How important are surgical margins in nephron-sparing surgery? Eur Urol Suppl. 2007;6:533–9.

    Article  Google Scholar 

  23. Saranchuk JW, Touijer AK, Hakimian P, Snyder ME, Russo P. Partial nephrectomy for patients with a solitary kidney: the Memorial Sloan-Kettering experience. BJU Int. 2004;94:1323–8.

    Article  PubMed  Google Scholar 

  24. Minervini A, Ficarra V, Rocco F, et al. Simple enucleation is equivalent to traditional partial nephrectomy for renal cell carcinoma: results of a nonrandomized, retrospective, comparative study. J Urol. 2011;185:1604–10.

    Article  PubMed  Google Scholar 

  25. Minervini A, Di Cristofano C, Lapini A, et al. Histopathological analysis of peritumoral pseudocapsule and surgical margins status after tumor enucleation for renal cell carcinoma. Eur Urol. 2009;55:1410–8.

    Article  PubMed  Google Scholar 

  26. Ficarra V, Galfano A, Cavalleri S. Is simple enucleation a minimal partial nephrectomy responding to the EAU Guidelines’ recommendations? Eur Urol. 2009;55:1315–8.

    Article  PubMed  Google Scholar 

  27. Minervini A, Serni S, Di Cristofano C, Carini M. Rebuttal from authors re: Vincenzo Ficarra, Antonio Galfano and Stefano Cavalleri. Is simple enucleation a minimal partial nephrectomy responding to the EAU guidelines’ recommendations? Eur Urol. 2009;55:1319–20.

    Article  PubMed  Google Scholar 

  28. Cambio AJ, Evans CP. Management approaches to small renal tumors. BJU Int. 2006;97:456–60.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Careggi Hospital, University of Florence, Florence, Italy

    Andrea Minervini MD, PhD, Sergio Serni MD, Agostino Tuccio MD, Giampaolo Siena MD, Gianni Vittori MD, Lorenzo Masieri MD, PhD, Saverio Giancane MD, Michele Lanciotti MD, Saba Khorrami MD, Alberto Lapini MD & Marco Carini MD

Authors
  1. Andrea Minervini MD, PhD
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  2. Sergio Serni MD
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  3. Agostino Tuccio MD
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  4. Giampaolo Siena MD
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  5. Gianni Vittori MD
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  6. Lorenzo Masieri MD, PhD
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  7. Saverio Giancane MD
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  8. Michele Lanciotti MD
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  9. Saba Khorrami MD
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  10. Alberto Lapini MD
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  11. Marco Carini MD
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Corresponding author

Correspondence to Andrea Minervini MD, PhD.

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Minervini, A., Serni, S., Tuccio, A. et al. Simple Enucleation Versus Radical Nephrectomy in the Treatment of pT1a and pT1b Renal Cell Carcinoma. Ann Surg Oncol 19, 694–700 (2012). https://doi.org/10.1245/s10434-011-2003-x

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  • DOI: https://doi.org/10.1245/s10434-011-2003-x

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