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12.08.2016 | Original Article

Nephron sparing surgery for renal cell carcinoma up to 7 cm in the context of guideline development: a contribution of healthcare research

verfasst von: Steffen Lebentrau, Sven Rauter, Daniel Baumunk, Frank Christoph, Frank König, Matthias May, Martin Schostak

Erschienen in: World Journal of Urology | Ausgabe 5/2017

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Abstract

Introduction

If technically feasible, organ-preservation is indicated for T1 renal cell carcinoma (RCC), since partial nephrectomy (PN) is equivalent to radical nephrectomy with regard to tumor-specific survival and probably achieves better overall survival. Treatment results of a training clinic were assessed with regard to guideline adherence and treatment quality.

Methods

Based on 220 open interventions in the time periods 2006–2009 (TP1) and 2010–2013 (TP2), a retrospective single center examination was performed to determine the influence of patient-age, sex, BMI, ASA-score, preoperative eGFR, PADUA-score and surgeon’s experience on PN-rate and trifecta-outcome (R0 resection, warm ischemia time ≤25 min, no intraoperative complications and no blood-transfusion and postoperative complications grade ≤1 Clavien and Dindo).

Results

PN-rate increased from 36.1 % in TP1 to 72.4 % in TP2. Despite significantly higher PADUA-scores in TP2 than in TP1 (p = 0.0038), the trifecta-rate did not differ significantly (TP1 65.7 %; TP2 70.8 %; p = 0.666). Only the PADUA-score exerted an independent influence on the endpoints “organ-preservation” and “trifecta-outcome”.

Conclusions

This study again demonstrated that the PADUA-score is a robust predictor of technical feasibility and treatment outcome for open PN. Consistent implementation of guidelines for nephron sparing surgery in RCC ≤7 cm is possible even in the setting of a training clinic and need not be associated with compromised treatment quality despite the increasing level of difficulty. Depending on the author, there are various definitions of trifecta-outcome. A uniform trifecta-concept would be desirable.

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Titel: Nephron sparing surgery for renal cell carcinoma up to 7 cm in the context of guideline development: a contribution of healthcare research
verfasst von: Steffen Lebentrau
Sven Rauter
Daniel Baumunk
Frank Christoph
Frank König
Matthias May
Martin Schostak
Publikationsdatum: 12.08.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 5/2017
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-016-1905-4

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Nephron sparing surgery for renal cell carcinoma up to 7 cm in the context of guideline development: a contribution of healthcare research

Abstract

Introduction

Methods

Results

Conclusions

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