Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience.
OBJECTIVE
We compared cancer specific survival of patients undergoing partial and radical nephrectomies for T1N0M0 renal tumors according to tumor size in a large multicenter series.


METHODS
A retrospective analysis of 1454 patients undergoing partial or radical nephrectomy for T1N0M0 renal tumors from 7 international academic centers was performed. Data were obtained for each patient including TNM stage (determined according to the 2002 TNM criteria), tumor size, type of surgery (partial versus radical nephrectomy) and cancer specific survival. Recurrence events were recorded when available.


RESULTS
Partial and radical nephrectomies were performed in 379 (26.1%) and 1075 (73.9%) cases, respectively. Mean followup +/- SD was 62.5 +/- 51.8 months. Recurrence data were available on 544 patients. There were no significant differences in local or distant recurrence rates between patients undergoing partial or radical nephrectomy for either T1a (p = 0.6) or T1b tumors (p = 0.5). For patients with T1a tumors, there was no significant difference in the rate of cancer specific deaths between the partial (314) and radical (499) nephrectomy groups (2.2% versus 2.6%, respectively, p = 0.8). For patients with T1b tumors there was also no significant difference in the rate of cancer specific deaths between patients undergoing partial (65) and patients undergoing radical (576) nephrectomy (6.2% versus 9%, respectively, p = 0.6).


CONCLUSIONS
Partial nephrectomy is becoming the gold standard for renal tumors less than 4 cm but this treatment is much more controversial for larger T1 tumors. This large multicenter study suggests that it is safe to expand the indications of partial nephrectomy to include patients with T1N0M0 tumors up to 7 cm. However, careful patient selection remains necessary.
Patard
Jean-Jacques
JJ
Department of Urology, University of California Los Angeles, Los Angeles, California 90095-1738, USA.
Shvarts
Oleg
O
Lam
John S
JS
Pantuck
Allan J
AJ
Kim
Hyung L
HL
Ficarra
Vincenzo
V
Cindolo
Luca
L
Han
Ken-Ryu
KR
De La Taille
Alexandre
A
Tostain
Jacques
J
Artibani
Walter
W
Abbou
Claude C
CC
Lobel
Bernard
B
Chopin
Dominique K
DK
Figlin
Robert A
RA
Mulders
Peter F A
PF
Belldegrun
Arie S
AS
D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate