Abstract

No AccessJournal of UrologyAdult urology1 Feb 2008Radical Nephrectomy for pT1a Renal Masses May be Associated With Decreased Overall Survival Compared With Partial Nephrectomyis corrected byErratum R. Houston Thompson, Stephen A. Boorjian, Christine M. Lohse, Bradley C. Leibovich, Eugene D. Kwon, John C. Cheville, and Michael L. Blute R. Houston ThompsonR. Houston Thompson Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota , Stephen A. BoorjianStephen A. Boorjian Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota , Christine M. LohseChristine M. Lohse Department of Health Sciences Research, Mayo Medical School and Mayo Clinic, Rochester, Minnesota , Bradley C. LeibovichBradley C. Leibovich Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota , Eugene D. KwonEugene D. Kwon Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota , John C. ChevilleJohn C. Cheville Department of Laboratory Medicine and Pathology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota , and Michael L. BluteMichael L. Blute Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota View All Author Informationhttps://doi.org/10.1016/j.juro.2007.09.077AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We reviewed our surgical experience with small renal tumors, comparing overall survival in patients treated with radical and partial nephrectomy. Materials and Methods: Using our nephrectomy registry we identified patients with sporadic, unilateral, solitary and localized renal masses 4 cm or less who underwent radical or partial nephrectomy between 1989 and 2003. Patients with a solitary kidney or impaired renal function at presentation were excluded, leaving 648 available for analysis. Overall survival was estimated using the Kaplan-Meier method and associations with death were evaluated using Cox proportional hazards regression. Results: At last followup 146 patients had died of any cause and 502 were alive at a median of 7.1 years. Radical and partial nephrectomy was performed in 290 and 358 patients, respectively. In all patients radical nephrectomy was not significantly associated with death from any cause compared with partial nephrectomy (RR 1.12, p = 0.52). However, there was a significant interaction with age, leading us to stratify our analysis at the median age of 65 years. In 327 patients younger than 65 years radical nephrectomy was significantly associated with death from any cause compared with partial nephrectomy (RR 2.16, p = 0.02). The increased risk of death persisted after adjusting for year of surgery (p = 0.02), preoperative creatinine (p = 0.03), Charlson-Romano index (p = 0.04), symptoms at presentation (p = 0.02), diabetes at presentation (p = 0.03) and histology (p = 0.02). Conclusions: Our results suggest that, compared with partial nephrectomy, radical nephrectomy is associated with decreased overall survival in younger patients with small renal masses. References 1 : The results of radical nephrectomy for renal cell carcinoma. J Urol1969; 101: 297. Link, Google Scholar 2 : Treatment of renal cell carcinoma by in situ partial nephrectomy and extracorporeal operation with autotransplantation. Mayo Clin Proc1985; 60: 651. Crossref, Medline, Google Scholar 3 : Conservative surgery for renal cell carcinoma: a single-center experience with 100 patients. J Urol1989; 141: 835. Link, Google Scholar 4 : The impact of ischemia time during open nephron sparing surgery on solitary kidneys: a multi-institutional study. J Urol2007; 177: 471. Link, Google Scholar 5 : Nephron sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm results in outcome similar to radical nephrectomy. J Urol2004; 171: 1066. Link, Google Scholar 6 : Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol2006; 7: 735. Google Scholar 7 : Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience. J Urol2004; 171: 2181. Link, Google Scholar 8 : Matched comparison of radical nephrectomy vs nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin Proc2000; 75: 1236. Crossref, Medline, Google Scholar 9 : Elective nephron sparing surgery should become standard treatment for small unilateral renal cell carcinoma: Long-term survival data of 216 patients. Eur Urol2006; 49: 308. Google Scholar 10 : Surgical management of renal tumors 4 cm. or less in a contemporary cohort. J Urol2000; 163: 730. Link, Google Scholar 11 : Partial nephrectomy for small renal masses: an emerging quality of care concern?. J Urol2006; 175: 853. Link, Google Scholar 12 : A description of radical nephrectomy practice and outcomes in England: 1995–2002. BJU Int2005; 96: 58. Google Scholar 13 : Complications of contemporary open nephron sparing surgery: a single institution experience. J Urol2005; 174: 855. Link, Google Scholar 14 : Comparative analysis of laparoscopic versus open partial nephrectomy for renal tumors in 200 patients. J Urol2003; 170: 64. Link, Google Scholar 15 : 5-Year outcomes of laparoscopic partial nephrectomy. J Urol2007; 177: 70. Link, Google Scholar 16 : Association of kidney function with incident hip fracture in older adults. J Am Soc Nephrol2007; 18: 282. Google Scholar 17 : Radical nephrectomy: too radical for small renal masses?. Lancet2006; 368: 823. Google Scholar 18 : Comparison between open partial and radical nephrectomy for renal tumours: perioperative outcome and health-related quality of life. Eur Urol2007; 51: 614. Google Scholar 19 : Comparison of direct hospital costs and length of stay for radical nephrectomy versus nephron-sparing surgery in the management of localized renal cell carcinoma. Urology1999; 54: 994. Google Scholar 20 : A comparison of hospital-based charges following partial and radical nephrectomy. Urol Oncol2002; 7: 3. Google Scholar © 2008 by American Urological AssociationFiguresReferencesRelatedDetailsCited byHuang W, Donin N, Levey A and Campbell S (2019) Chronic Kidney Disease and Kidney Cancer Surgery: New PerspectivesJournal of Urology, VOL. 203, NO. 3, (475-485), Online publication date: 1-Mar-2020.Cadeddu J (2019) Re: Oncologic Outcomes following Partial Nephrectomy and Percutaneous Ablation for cT1 Renal MassesJournal of Urology, VOL. 203, NO. 1, (28-28), Online publication date: 1-Jan-2020.Laguna M (2019) Re: Comparison of RENAL, PADUA, CSA, and PAVP Nephrometry Scores in Predicting Functional Outcomes after Partial NephrectomyJournal of Urology, VOL. 202, NO. 4, (657-658), Online publication date: 1-Oct-2019.Laguna M (2019) Re: Outcomes of Pathologic Stage T3a Renal Cell Carcinoma Up-Staged from Small Renal Tumor: Emphasis on Partial NephrectomyJournal of Urology, VOL. 201, NO. 2, (224-225), Online publication date: 1-Feb-2019.Laguna M (2017) Re: Management of Small Renal Masses: American Society of Clinical Oncology Clinical Practice GuidelineJournal of Urology, VOL. 198, NO. 3, (480-482), Online publication date: 1-Sep-2017.Flum A, Hamoui N, Said M, Yang X, Casalino D, McGuire B, Perry K and Nadler R (2015) Update on the Diagnosis and Management of Renal AngiomyolipomaJournal of Urology, VOL. 195, NO. 4 Part 1, (834-846), Online publication date: 1-Apr-2016.Laguna M (2015) Re: Partial Nephrectomy for the Treatment of Renal Cell Carcinoma (RCC) and the Risk of End-Stage Renal Disease (ESRD)Journal of Urology, VOL. 194, NO. 5, (1226-1228), Online publication date: 1-Nov-2015.Chang S (2014) Renal Surgery and its Impact on Chronic Kidney Disease: A Continuing Evolution in Decision MakingJournal of Urology, VOL. 192, NO. 4, (1017-1018), Online publication date: 1-Oct-2014.Laguna M (2014) Re: Renal Function after Nephron-Sparing Surgery versus Radical Nephrectomy: Results from EORTC Randomized Trial 30904Journal of Urology, VOL. 192, NO. 2, (369-370), Online publication date: 1-Aug-2014.Laguna M (2014) Re: Overall Survival and Development of Stage IV Chronic Kidney Disease in Patients Undergoing Partial and Radical Nephrectomy for Benign Renal TumorsJournal of Urology, VOL. 191, NO. 6, (1729-1730), Online publication date: 1-Jun-2014.Scosyrev E, Wu K, Levey H, Agrawal V, Beckham C, Wu G and Messing E (2014) Overall Survival after Partial Versus Radical Nephrectomy for a Small Renal Mass: Systematic Review of Observational StudiesUrology Practice, VOL. 1, NO. 1, (27-34), Online publication date: 1-May-2014.Tobert C, Boelkins B, Culver S, Mammen L, Kahnoski R and Lane B (2013) Surgeon Assessment of Renal Preservation with Partial Nephrectomy Provides Information Comparable to Measurement of Volume Preservation with 3-Dimensional Image AnalysisJournal of Urology, VOL. 191, NO. 5, (1218-1224), Online publication date: 1-May-2014.Ching C, Lane B, Campbell S, Li J and Fergany A (2013) Five to 10-Year Followup of Open Partial Nephrectomy in a Solitary KidneyJournal of Urology, VOL. 190, NO. 2, (470-474), Online publication date: 1-Aug-2013.Lane B, Campbell S and Gill I (2013) 10-Year Oncologic Outcomes After Laparoscopic and Open Partial NephrectomyJournal of Urology, VOL. 190, NO. 1, (44-49), Online publication date: 1-Jul-2013.Jain S, Nyirenda T, Yates J and Munver R (2012) Incidence of Renal Artery Pseudoaneurysm Following Open and Minimally Invasive Partial Nephrectomy: A Systematic Review and Comparative AnalysisJournal of Urology, VOL. 189, NO. 5, (1643-1648), Online publication date: 1-May-2013.Lane B, Campbell S, Demirjian S and Fergany A (2012) Surgically Induced Chronic Kidney Disease May be Associated with a Lower Risk of Progression and Mortality than Medical Chronic Kidney DiseaseJournal of Urology, VOL. 189, NO. 5, (1649-1655), Online publication date: 1-May-2013.Singer E, Vourganti S, Lin K, Gupta G, Pinto P, Rastinehad A, Linehan W and Bratslavsky G (2012) Outcomes of Patients with Surgically Treated Bilateral Renal Masses and a Minimum of 10 Years of FollowupJournal of Urology, VOL. 188, NO. 6, (2084-2088), Online publication date: 1-Dec-2012.Smaldone M, Egleston B, Uzzo R and Kutikov A (2012) Does Partial Nephrectomy Result in a Durable Overall Survival Benefit in the Medicare Population?Journal of Urology, VOL. 188, NO. 6, (2089-2094), Online publication date: 1-Dec-2012.Buethe D, Moussly S, Lin H, Yue B, Rodriguez A, Spiess P and Sexton W (2012) Is the R.E.N.A.L. 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Houston Thompson Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota More articles by this author Stephen A. Boorjian Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota More articles by this author Christine M. Lohse Department of Health Sciences Research, Mayo Medical School and Mayo Clinic, Rochester, Minnesota More articles by this author Bradley C. Leibovich Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota More articles by this author Eugene D. Kwon Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota More articles by this author John C. Cheville Department of Laboratory Medicine and Pathology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota More articles by this author Michael L. Blute Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota More articles by this author Expand All Advertisement PDF downloadLoading ...