title: [Do broader indications for partial nephrectomy result in excess morbidity?].
abstract: OBJECTIVE
  To evaluate the morbidity of partial nephrectomy (PN) according to tumour size and the type of indication based on a multicentre retrospective study.
  
  
  METHODS
  Seven French teaching hospitals participated in this study. Data concerning tumour size, indication for PN (elective or necessity), age, gender, TNM stage, histological type, Fuhrman grade, ASA score and performance status (ECOG) were analysed. Medical and surgical complications, intraoperative blood loss, blood transfusion rate and length of hospital stay were also studied. Statistical analysis of qualitative and quantitative variables was performed with Chi-square test (Fisher's test) and Student t-test.
  
  
  RESULTS
  Six hundred and ninety one patients were included. The median tumour diameter was 3cm (0.4-18). Tumours measuring less or equal to 4cm and incidental tumours represented 77.7 and 80.7% of cases, respectively. Clear cell carcinomas represented 75.1% of malignant tumours. Some 89.1% of tumours were T1, 1.6% were N+ and 2.3% were M+. In the 486 elective indications: the operating time (p = 0.03), mean blood loss (p = 0.04), and urinary fistula rate (p = 0.01) were significantly higher in tumours greater than 4cm. These differences were not associated with an increase in the medical (p = 0.7) or surgical complication rate (p = 0.2), or the length of hospital stay (p = 0.4).
  
  
  CONCLUSIONS
  Broader indications for elective PN is associated with an increased morbidity but which remains acceptable. This is an important point for patient information and to guide the choice of surgical strategy, particularly in elderly, frail patients or patients with major comorbidities.
authors.affiliation: Service d'urologie, CHU de Rennes, rue Henri-Le-Guillou, 35033 Rennes, France.
authors.forename: G
authors.initials: G
authors.lastname: Verhoest
authors.forename: M
authors.initials: M
authors.lastname: Crepel
authors.forename: J-C
authors.initials: JC
authors.lastname: Bernhard
authors.forename: L
authors.initials: L
authors.lastname: Bellec
authors.forename: B
authors.initials: B
authors.lastname: Albouy
authors.forename: D
authors.initials: D
authors.lastname: Lopes
authors.forename: B
authors.initials: B
authors.lastname: Lacroix
authors.forename: A
authors.initials: A
authors.lastname: De La Taille
authors.forename: L
authors.initials: L
authors.lastname: Salomon
authors.forename: C
authors.initials: C
authors.lastname: Pfister
authors.forename: M
authors.initials: M
authors.lastname: Soulié
authors.forename: J
authors.initials: J
authors.lastname: Tostain
authors.forename: J-M
authors.initials: JM
authors.lastname: Ferrière
authors.forename: C C
authors.initials: CC
authors.lastname: Abbou
authors.forename: M
authors.initials: M
authors.lastname: Colombel
authors.forename: S
authors.initials: S
authors.lastname: Vincendeau
authors.forename: K
authors.initials: K
authors.lastname: Bensalah
authors.forename: A
authors.initials: A
authors.lastname: Manunta
authors.forename: F
authors.initials: F
authors.lastname: Guillé
authors.forename: J-J
authors.initials: JJ
authors.lastname: Patard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D005602:France; D006784:Hospitals, Teaching; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods* / Q000592:standards; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome