NEPHRON SPARING SURGERY FOR STAGE T1b RENAL CANCER

NEW YORK (Reuters Health) Jun 19 - Nephron-sparing surgery offers excellent outcomes for patients with stage T1b renal cell carcinoma (RCC), according to a report in the May BJU International.

"Our data confirm that renal function is very well preserved following surgery, with no significant loss in elective indications and a small but significant loss in imperative/relative indications," Dr. Steven Joniau from University Hospitals Leuven, Belgium, told Reuters Health. "This observation is extremely important, as many of these patients will not die of their cancer, and radical nephrectomy might put them at higher risk for chronic renal insufficiency and ultimately cardiovascular morbidity and death."

Dr. Joniau and colleagues reviewed 67 consecutive patients who underwent nephron-sparing surgery for RCC of 4 to 7 cm (i.e., T1b). Complications of surgery were few, the authors report, with 4 patients developing a perirenal hematoma, 3 experiencing delayed wound healing, 2 developing pneumonia, and 2 developing atrial fibrillation.

The median preoperative creatinine level was 1.19 mg/dL, which rose slightly to 1.31 after a median follow-up of 40.2 months.

Seven patients developed de novo renal insufficiency, 2 patients eventually needed hemodialysis, and 1 patient required a kidney transplant, the researchers note. Ten patients died during follow-up, but none of the deaths could be attributed directly to their RCC.

Seven patients had tumor recurrence, the investigators say, 3 locally outside the resection area and 4 locoregionally or with distant metastases.

Five-year clinical progression-free survival was 84%, cancer-specific survival was 99%, and overall survival was 72%. The rates did not differ significantly between patients who underwent nephron-sparing surgery for relative/elective or for absolute indications.

"The last couple of years, a growing body of publications have described the feasibility and oncological safety of nephron-sparing surgery in masses great than 4 and less than 7 cm," Dr. Joniau said. "Our report is a confirmation of the oncological outcomes reported by others."

"We believe that the feasibility of nephron-sparing surgery for T1 RCC should depend more on tumor location and surgeon experience with nephron-sparing surgery than on tumor size in isolation," the authors conclude.

BJU Int 2009;103:1344-1348.