[The impact of partial nephrectomy on morbidity and on long-term oncological outcomes].
OBJECTIVE
To evaluate the impact of imperative indication on the rate of complications and long term carcinological results after partial nephrectomy (PN).


METHODS
Between 1985 and 2005, all patients who had a PN for localized cancer in two centers were reviewed. The rates of global, hemorrhagic and urinary complications were compared between group I (elective indication) and group II (imperative indication). Rates of survival without recurrence and specific at 5, 10 and 20 years were compared between these two groups. A multivariate analysis using the Cox model was carried out to research factors associated with recurrence and death on the whole of the series.


RESULTS
Three hundred and five patients were included in the study. No significant difference was found between group I and group II as far as global complications were concerned (17 vs 20%), the rate of hemorrhagic complications (3.5 vs 3.8%) and the rate of urinary complications (3.9 vs 2.5%). The patients who had been operated on for an imperative indication had survived specifically and without recurrence which was significantly lower at 5, 10 and 20 years. On the whole of the series, the imperative indication was the only independent factor associated with recurrence and death in a multivariate analysis.


CONCLUSIONS
Even if the rate of complication does not appear to be significantly associated with the indication for operating, patients of imperative indication represented a heterogeneous group with a poorer prognosis. This factor should be taken into account in studies on the subject of PN.
Rouach
Y
Y
Service d'urologie, hôpital Necker, université René-Descartes, 69, rue Saint-Martin, 75004 Paris, France. yannickrouach@hotmail.com
Timsit
M-O
MO
Lebret
T
T
Fontaine
E
E
Yonneau
L
L
Herve
J-M
JM
Botto
H
H
Thiounn
N
N
Mejean
A
A
D000368:Aged; D017558:Elective Surgical Procedures / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000517:prevention & control*; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D010297:Paris; D011379:Prognosis; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome