title: Elective partial nephrectomy in patients with clinical T1b renal tumors is associated with improved overall survival.
abstract: OBJECTIVE
  Elective partial nephrectomy (PN) in patients with cT1b renal tumors is relatively unstudied. Most surgeons currently only perform radical nephrectomy (RN) in this population. Patients with localized kidney cancer may die from disease, but the risk of a non-cancerrelated death is significant and may be worsened by nephrectomy-induced chronic kidney disease (CKD). PN may offer the perfect combination of cancer control and preservation of renal function; therefore we compared overall and cancer-specific survival in patients treated for cT1b renal masses.
  
  
  METHODS
  From 1999 to 1906, 510 patients with renal tumors >4-7 cm, a glomerular filtration rate (GFR) >60, and a normal contralateral kidney underwent extirpative surgery (PN, n = 212 or RN, n = 298) at our institution. As the patients were not randomized, we generated a propensity model based on preoperative patient characteristics to control for selection bias.
  
  
  RESULTS
  Cancer-specific survival was similar between cohorts when compared by pathologic stage and grade. On multivariate analysis, RN was associated with postoperative CKD (odds ratio 3.4, 95% confidence interval [CI] 2.1-5.6). Survival analysis demonstrated that when controlling for the propensity score, PN was associated with better overall survival (hazard ratio 0.30, 95% CI = .13-.71).
  
  
  CONCLUSIONS
  Where technically feasible, PN offers cancer control equivalent to that of RN. Elective PN was associated with a significantly better overall survival in this cohort, even when controlling for age, tumor size, pathologic stage, and burden of comorbid diseases. The improvement in overall survival appears to be attributable in part to prevention of postoperative CKD.
authors.affiliation: Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Weight
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Larson
authors.forename: Tianming
authors.initials: T
authors.lastname: Gao
authors.forename: Steven C
authors.initials: SC
authors.lastname: Campbell
authors.forename: Brian R
authors.initials: BR
authors.lastname: Lane
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
authors.forename: Eric A
authors.initials: EA
authors.lastname: Klein
authors.forename: Amr F
authors.initials: AF
authors.lastname: Fergany
mesh_terms: D000368:Aged; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D015996:Survival Rate