title: Long-term outcomes after nephron sparing surgery for renal cell carcinoma larger than 4 cm.
abstract: OBJECTIVE
  We determined the cancer control provided by nephron sparing surgery for renal cell carcinoma greater than 4 cm.
  
  
  METHODS
  We performed a retrospective review of data on patients treated between 1980 and 2005. The case characteristics analyzed were patient age, surgical procedure, intraoperative parameters, complications, tumor size, Fuhrman grade, TNM stage, pathological data and outcome. Kaplan-Meier survival curves were generated.
  
  
  RESULTS
  Median age of the 61 patients was 64 years (range 40 to 83). Mean +/- SD intraoperative blood loss was 622 ml +/- 691 (range 50 to 4,800) and mean operative time was 155.7 +/- 82 minutes (range 52 to 360). Mean creatinine preoperatively and immediately postoperatively was 1.16 and 1.25 mg/dl, respectively. Mean renal cell carcinoma size was 56.3 +/- 18 mm (range 41 to 100). Margin status was positive in 11 cases (18%). Median followup was 70.7 months. The 5 and 10-year cancer specific survival rate was 81% and 78%, respectively. The tumor-free survival rate was 92% at 5 years and 88% at 10 years. On univariate analysis tumor size more than 7 cm (p = 0.002), pathological stage (p = 0.001) and Fuhrman grade (p = 0.004) were associated with survival. On multivariate analysis only pathological stage and Fuhrman grade were significant (p <0.0001 and 0.007, respectively).
  
  
  CONCLUSIONS
  Our results support the fact that nephron sparing surgery is a useful and acceptable approach to renal cell carcinoma greater than 4 cm. When technically possible, nephron sparing surgery provides acceptable long-term cancer specific survival rates. However, oncological safety is less evident in cases of renal cell carcinoma greater than 7 cm. To date in such cases nephron sparing surgery should only be considered for absolute indications.
authors.affiliation: Department of Urology, Groupement Hospitalier Universitaire Est (Pitié-Tenon), Assistance-Publique Hôpitaux de Paris and Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Peycelon
authors.forename: Vincent
authors.initials: V
authors.lastname: Hupertan
authors.forename: Eva
authors.initials: E
authors.lastname: Comperat
authors.forename: Raphaële
authors.initials: R
authors.lastname: Renard-Penna
authors.forename: Christophe
authors.initials: C
authors.lastname: Vaessen
authors.forename: Pierre
authors.initials: P
authors.lastname: Conort
authors.forename: Marc-Olivier
authors.initials: MO
authors.lastname: Bitker
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chartier-Kastler
authors.forename: François
authors.initials: F
authors.lastname: Richard
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome