Morbidity and clinical outcome of nephron-sparing surgery in relation to tumour size and indication.
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.
Patard
Jean-Jacques
JJ
Department of Urology, Rennes University Hospital, Rennes, France. jean-jacques.patard@univ-rennes1.fr
Pantuck
Allan J
AJ
Crepel
Maxime
M
Lam
John S
JS
Bellec
Laurent
L
Albouy
Baptiste
B
Lopes
David
D
Bernhard
Jean-Christophe
JC
Guillé
François
F
Lacroix
Bertrand
B
De La Taille
Alexandre
A
Salomon
Laurent
L
Pfister
Christian
C
Soulié
Michel
M
Tostain
Jacques
J
Ferriere
Jean-Marie
JM
Abbou
Claude C
CC
Colombel
Marc
M
Belldegrun
Arie S
AS
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