Nephron-sparing surgery for renal tumors measuring more than 7 cm: morbidity, and functional and oncological outcomes
2 Service d'urologie, andrologie et transplantation rénale
3 Service d'urologie [Mondor]
4 IMRB - Institut Mondor de Recherche Biomédicale
5 INSERM U955, équipe 7
6 Service d'urologie [CHU Cochin]
7 TIMC-IMAG - Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525
8 Service d'urologie
9 Service d'urologie
10 CHU Pitié-Salpêtrière [AP-HP]
11 FLIRT
12 Service d'Urologie [CHU Saint-Louis]
13 Service d'urologie [Rennes] = Urology [Rennes]
14 IGDR - Institut de Génétique et Développement de Rennes
15 urology
16 Service d'urologie
17 Service d'urologie
18 Département d'Urologie-Andrologie et Transplantation Rénale [CHU Toulouse]
19 Service d'urologie
20 Oncologie génito-urinaire
21 Service d'urologie [Centre Hospitalier Lyon Sud - HCL]
22 Imagerie moléculaire et fonctionnelle: de la physiologie à la thérapie
23 Service d'Imagerie Diagnostique et Interventionnelle de l'Adulte
24 Service de Génétique Moléculaire
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- ORCID : 0000-0002-9440-4895
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- ORCID : 0000-0002-6004-2152
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- ORCID : 0000-0002-4803-9196
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Résumé
BACKGROUND: The purpose of this study was to evaluate morbidity, functional, and oncological outcomes after NSS in renal tumors \textgreater 7 cm. MATERIALS AND METHODS: We retrospectively analyzed data from 168 patients with tumors \textgreater 7 cm who were treated using NSS between 1998 and 2012. RESULTS: Imperative and elective indications accounted for 76 (45.2%) and 92 (54.8%) patients, respectively. Major perioperative complications and renal function deterioration occurred in 33 (19.6%) and 51 patients (30.4%), respectively. In multivariate analysis, age older than 60 years (P = .001; hazard ratio [HR], 5) and tumor malignancy (P = .014; HR, 6.7) were prognostic factors for renal function deterioration whereas imperative indication was a risk factor for major postoperative complications (P = .0019; HR, 2.7). In 126 (75%) patients with malignant tumors, after a median follow-up of 30 months (range, 1-254 months), 25 patients (20.2%) died. In multivariate analysis, imperative indication (P = .023; HR, 4.2), positive surgical margin (P = .021; HR, 3.3), and Fuhrman grade \textgreater II (P = .013; HR, 3.7) were prognostic indicators for cancer-free survival (CFS). Imperative indication (P = .04; HR, 8.5) and Fuhrman grade \textgreater II (P = .04; HR, 3.9) were predictive factors of cancer-specific survival (CSS). In case of elective indication, positive surgical margin, local recurrence, and cancer-related death occurred in 4 (7.6%), 1 (1.1%), and 1 (1.1%) cases, respectively. For elective indication, 5-year estimates of CFS, CSS, and overall survival rates were: 85.7%, 98%, and 93.9%, respectively. CONCLUSION: In this selected population, imperative vs. elective indication status seems to play a critical role in oncologic outcomes. Oncologic results for elective indications are close to those reported with radical nephrectomy.