Clinical characteristics and functional and oncologic results of patients with kidney tumors that underwent partial nephrectomy

Authors

  • Javier Antonio Herrera Muñoz Instituto Nacional De Cancerología (INCan), Ciudad de México, México
  • Diego Antonio Preciado Estrella Instituto Nacional De Cancerología (INCan), Ciudad de México, México
  • Luis Villalpando Gómez Instituto Nacional De Cancerología (INCan), Ciudad de México, México
  • Zael Santana Ríos Instituto Nacional De Cancerología (INCan), Ciudad de México, México
  • Pedro Martínez Cervera Instituto Nacional De Cancerología (INCan), Ciudad de México, México
  • Anna Scavuzzo Instituto Nacional De Cancerología (INCan), Ciudad de México, México
  • Miguel Ángel Jiménez-Ríos Instituto Nacional De Cancerología (INCan), Ciudad de México, México

DOI:

https://doi.org/10.48193/revistamexicanadeurologa.v79i1.393

Keywords:

Neferectomía parcial

Abstract

Background: Partial nephrectomy has become standard treatment for T1 tumors (£ 7 cm), solitary kidney, bilateral tumors, and hereditary cancer. There are few studies in Mexico that report on said procedure.

Aim: To know the clinical characteristics, perioperative morbidity, and functional and oncologic results of partial nephrectomy at the Instituto Nacional De Cancerología

Materials and methods: A retrospective, analytic study was conducted on patients that underwent partial nephrectomy within the time frame of 2000 to 2018, reporting the oncologic and perioperative results.

Results: Seventy-nine patients that underwent partial nephrectomy were analyzed. A total of 82 procedures were performed. Mean patient age was 52 years. Clinical stage was T1a and T1b in 62 (74.6%) and 20 (24.4%) cases, respectively. Warm ischemia was utilized in 39 (47.6%) patients and n ischemia was used in 35 (42.7%). Mean surgery duration was 162 min, mean blood loss was 449 ml, and mean hospital stay was 2.1 days. Open surgery was performed on 70 (85.4%) patients and 12 (14.6%) patients underwent the laparoscopic procedure. There were early complications in 17 (20%) patients that included 9 (11%) transfusions. Clear cell renal cell carcinoma was reported in 66 (80.5%) cases and surgical margins were negative in 73 (89%). Cancer-specific survival was 100% and overall survival was 92% at five years. The mean preoperative estimated glomerular filtration rate was 88 ml/min and it was 79 ml/min at one year. Renal ischemia influenced the decrease in the glomerular filtration rate.

Conclusions: The results of the present study are similar to those reported in other international referral centers, making the performance of partial nephrectomy in T1 tumors a safe procedure in our population.

References

Campbell S, Uzzo RG, Allaf ME, Bass EB, Cadeddu JA, Chang A, et al. Renal Mass and Localized Renal Cancer: AUA Guideline. J Urol. 2017;198(3):520–9. doi: 10.1016/j.juro.2017.04.100

NCCN. NCCN Guidelines for Patients. Prostate Cancer. Plymouth: National Comprehensive Cancer Network; 2018.

Agrawal S, Sedlacek H, Kim SP. Comparative Effectiveness of Surgical Treatments for Small Renal Masses. Urol Clin North Am. 2017;44(2):257–67. doi: 10.1016/j.ucl.2016.12.011

Lee HJ, Liss MA, Derweesh IH. Outcomes of partial nephrectomy for clinical T1b and T2 renal tumors. Curr Opin Urol. 2014;24(5):448–52. doi: 10.1097/MOU.0000000000000081

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 Jan;181(1):55–61; discussion 61-62. doi: 10.1016/j.juro.2008.09.017

Van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A, Borkowski A, 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(4):543–52. doi: 10.1016/j.eururo.2010.12.013

Novara G, La Falce S, Kungulli A, Gandaglia G, Ficarra V, Mottrie A. Robot-assisted partial nephrectomy. Int J Surg Lond Engl. 2016;36(Pt C):554–9. doi: 10.1016/j.ijsu.2016.05.073

Andrade HS, Zargar H, Caputo PA, Akca O, Kara O, Ramirez D, et al. Five-year Oncologic Outcomes After Transperitoneal Robotic Partial Nephrectomy for Renal Cell Carcinoma. Eur Urol. 2016;69(6):1149–54. doi: 10.1016/j.eururo.2015.12.004

Steinestel J, Steffens S, Steinestel K, Schrader AJ. Positive surgical margins in nephron-sparing surgery: risk factors and therapeutic consequences. World J Surg Oncol. 2014;12. [accessed 4 Apr 2019] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4249770/

Shah PH, Moreira DM, Okhunov Z, Patel VR, Chopra S, Razmaria AA, et al. Positive Surgical Margins Increase Risk of Recurrence after Partial Nephrectomy for High Risk Renal Tumors. J Urol. 2016;196(2):327–34. doi: 10.1016/j.juro.2016.02.075

Kim SP, Abouassaly R. Treatment of Patients with Positive Margins after Partial Nephrectomy. J Urol. 2016;196(2):301–2. doi: 10.1016/j.juro.2016.05.078

Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

Zaid HB, Parker WP, Lohse CM, Cheville JC, Boorjian SA, Leibovich BC, et al. Patient factors associated with 30-day complications after partial nephrectomy: A contemporary update. Urol Oncol. 2017;35(4):153.e1-153.e6. doi: 10.1016/j.urolonc.2016.11.001

Spana G, Haber G-P, Dulabon LM, Petros F, Rogers CG, Bhayani SB, et al. Complications after robotic partial nephrectomy at centers of excellence: multi-institutional analysis of 450 cases. J Urol. 2011;186(2):417–21. doi: 10.1016/j.juro.2011.03.127

Van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A, Borkowski A, et al. A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol. 2007;51(6):1606–15. doi: 10.1016/j.eururo.2006.11.013

Mir MC, Pavan N, Parekh DJ. Current Paradigm for Ischemia in Kidney Surgery. J Urol. 2016;195(6):1655–63. doi: 10.1016/j.juro.2015.09.099

Funahashi Y, Yoshino Y, Sassa N, Matsukawa Y, Takai S, Gotoh M. Comparison of warm and cold ischemia on renal function after partial nephrectomy. Urology. 2014;84(6):1408–12. doi: 10.1016/j.urology.2014.08.040

Deng W, Liu X, Hu J, Chen L, Fu B. Off-clamp partial nephrectomy has a positive impact on short- and long-term renal function: a systematic review and meta-analysis. BMC Nephrol. 2018;19(1):188. [accessed 4 Apr 2019] Available from: https://doi.org/10.1186/s12882-018-0993-3

Lau WK, Blute ML, Weaver AL, Torres VE, Zincke H. Matched comparison of radical nephrectomy vs nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin Proc. 2000;75(12):1236–42.

Kim SP, Thompson RH, Boorjian SA, Weight CJ, Han LC, Murad MH, et al. Comparative effectiveness for survival and renal function of partial and radical nephrectomy for localized renal tumors: a systematic review and meta-analysis. J Urol. 2012;188(1):51–7. doi: 10.1016/j.juro.2012.03.006

Scosyrev E, Messing EM, Sylvester R, Campbell S, Poppel HV. Renal Function After Nephron-sparing Surgery Versus Radical Nephrectomy: Results from EORTC Randomized Trial 30904. Eur Urol. 2014;65(2):372–7. [accessed 4 Apr 2019] Available from: https://www.europeanurology.com/article/S0302-2838(13)00659-3/abstract

Capitanio U, Terrone C, Antonelli A, Minervini A, Volpe A, Furlan M, et al. Nephron-sparing techniques independently decrease the risk of cardiovascular events relative to radical nephrectomy in patients with a T1a-T1b renal mass and normal preoperative renal function. Eur Urol. 2015;67(4):683–9. doi: 10.1016/j.eururo.2014.09.027

Krane LS, Hemal AK. Emerging technologies to improve techniques and outcomes of robotic partial nephrectomy: striving toward the pentafecta. Urol Clin North Am. 2014;41(4):511–9. doi: 10.1016/j.ucl.2014.07.006

Leow JJ, Heah NH, Chang SL, Chong YL, Png KS. Outcomes of Robotic versus Laparoscopic Partial Nephrectomy: an Updated Meta-Analysis of 4,919 Patients. J Urol. 2016;196(5):1371–7. doi: 10.1016/j.juro.2016.06.011

Lane BR, Gill IS. 7-year oncological outcomes after laparoscopic and open partial nephrectomy. J Urol. 2010;183(2):473–9. doi: 10.1016/j.juro.2009.10.023

Aboumarzouk OM, Stein RJ, Eyraud R, Haber G-P, Chlosta PL, Somani BK, et al. Robotic versus laparoscopic partial nephrectomy: a systematic review and meta-analysis. Eur Urol. 2012;62(6):1023–33. doi: 10.1016/j.eururo.2012.06.038

Khalifeh A, Autorino R, Hillyer SP, Laydner H, Eyraud R, Panumatrassamee K, et al. Comparative outcomes and assessment of trifecta in 500 robotic and laparoscopic partial nephrectomy cases: a single surgeon experience. J Urol. 2013;189(4):1236–42. doi: 10.1016/j.juro.2012.10.021

Uberetagoyena-Tello de Meneses I, Sedano-Basilio JE, Trujillo-Ortiz L, Palmeros-Rodríguez A, Cornejo-Dávila V, Martínez-Arroyo C, et al. Resultados oncológicos y seguimiento en pacientes con cáncer renal localizado sometidos a nefrectomía parcial. Rev Mex Urol. 2016;76(2):94–8. [accessed 4 Apr 2019] Available from: http://www.sciencedirect.com/science/article/pii/S2007408516000148

Lucas SM, Mellon MJ, Erntsberger L, Sundaram CP. A comparison of robotic, laparoscopic and open partial nephrectomy. JSLS. 2012;16(4):581–7. doi: 10.4293/108680812X13462882737177

Simhan J, Smaldone MC, Tsai KJ, Li T, Reyes JM, Canter D, et al. Perioperative outcomes of robotic and open partial nephrectomy for moderately and highly complex renal lesions. J Urol. 2012;187(6):2000–4. doi: 10.1016/j.juro.2012.01.064

Ghani KR, Sukumar S, Sammon JD, Rogers CG, Trinh Q-D, Menon M. Practice patterns and outcomes of open and minimally invasive partial nephrectomy since the introduction of robotic partial nephrectomy: results from the nationwide inpatient sample. J Urol. 2014;191(4):907–12. doi: 10.1016/j.juro.2013.10.099

Choi JE, You JH, Kim DK, Rha KH, Lee SH. Comparison of perioperative outcomes between robotic and laparoscopic partial nephrectomy: a systematic review and meta-analysis. Eur Urol. 2015;67(5):891–901. doi: 10.1016/j.eururo.2014.12.028

Tabayoyong W, Abouassaly R, Kiechle JE, Cherullo EE, Meropol NJ, Shah ND, et al. Variation in Surgical Margin Status by Surgical Approach among Patients Undergoing Partial Nephrectomy for Small Renal Masses. J Urol. 2015;194(6):1548–53. doi: 10.1016/j.juro.2015.06.076

Wood EL, Adibi M, Qiao W, Brandt J, Zhang M, Tamboli P, et al. Local Tumor Bed Recurrence Following Partial Nephrectomy in Patients with Small Renal Masses. J Urol. 2018;199(2):393–400. doi: 10.1016/j.juro.2017.09.072

Funahashi Y, Hattori R, Yamamoto T, Kamihira O, Kato K, Gotoh M. Ischemic renal damage after nephron-sparing surgery in patients with normal contralateral kidney. Eur Urol. 2009;55(1):209–15. doi: 10.1016/j.eururo.2008.07.048

Published

2019-04-09

Issue

Section

Original articles