title: Morbidity and clinical outcome of nephron-sparing surgery in relation to tumour size and indication.
abstract: OBJECTIVE
  To analyse through a large multicentre series, morbidity of nephron-sparing surgery (NSS) in relation to tumour size and surgical indication.
  
  
  METHODS
  The study included patients from eight international academic centres. Age, sex, TNM stage, tumour size, Fuhrman grade, Eastern Cooperative Oncology Group performance status (ECOG-PS), surgical margins, local and distant recurrences, and overall and cancer-specific survival rates were collected and analysed. Indication for elective or mandatory NSS, medical and surgical complication rates, mean blood loss, blood transfusion, and length of hospital stay were specifically recorded for the purpose of this study. Groups were compared for qualitative and quantitative variables by using chi(2) (Fischer exact test) and Student t tests, respectively.
  
  
  RESULTS
  A total of 1048 NSS procedures were included in this study. Mean tumour size was 3.4+/-2.1cm. In 730 elective procedures mean operative time (p=0.002), mean blood loss (p=0.01), the need for blood transfusion (p=0.001), and urinary fistula rate (p=0.01) were significantly increased for tumours >4 cm. However, these differences did not result in significantly increased medical (p=0.4), surgical complication rates (p=0.6), or length of hospital stay (p=0.9). Finally, in elective procedures for malignant tumours, positive surgical margins, local or distant recurrence rates, and cancer-specific survival were not significantly different in tumours < or =4 cm and >4 cm.
  
  
  CONCLUSIONS
  Excellent cancer control and outcomes can be achieved with NSS in carefully selected patients with tumours >4 cm. Expanding the size indication of elective NSS results in an increased but acceptable morbidity.
authors.affiliation: Department of Urology, Rennes University Hospital, Rennes, France. jean-jacques.patard@univ-rennes1.fr
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Patard
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Pantuck
authors.forename: Maxime
authors.initials: M
authors.lastname: Crepel
authors.forename: John S
authors.initials: JS
authors.lastname: Lam
authors.forename: Laurent
authors.initials: L
authors.lastname: Bellec
authors.forename: Baptiste
authors.initials: B
authors.lastname: Albouy
authors.forename: David
authors.initials: D
authors.lastname: Lopes
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Bernhard
authors.forename: François
authors.initials: F
authors.lastname: Guillé
authors.forename: Bertrand
authors.initials: B
authors.lastname: Lacroix
authors.forename: Alexandre
authors.initials: A
authors.lastname: De La Taille
authors.forename: Laurent
authors.initials: L
authors.lastname: Salomon
authors.forename: Christian
authors.initials: C
authors.lastname: Pfister
authors.forename: Michel
authors.initials: M
authors.lastname: Soulié
authors.forename: Jacques
authors.initials: J
authors.lastname: Tostain
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Ferriere
authors.forename: Claude C
authors.initials: CC
authors.lastname: Abbou
authors.forename: Marc
authors.initials: M
authors.lastname: Colombel
authors.forename: Arie S
authors.initials: AS
authors.lastname: Belldegrun
mesh_terms: D002140:California / Q000453:epidemiology; D002292:Carcinoma, Renal Cell / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors