title: Nephron-sparing surgery for renal tumors measuring more than 7 cm: morbidity, and functional and oncological outcomes.
abstract: BACKGROUND
  The purpose of this study was to evaluate morbidity, functional, and oncological outcomes after NSS in renal tumors > 7 cm.
  
  
  METHODS
  We retrospectively analyzed data from 168 patients with tumors > 7 cm who were treated using NSS between 1998 and 2012.
  
  
  RESULTS
  Imperative and elective indications accounted for 76 (45.2%) and 92 (54.8%) patients, respectively. Major perioperative complications and renal function deterioration occurred in 33 (19.6%) and 51 patients (30.4%), respectively. In multivariate analysis, age older than 60 years (P = .001; hazard ratio [HR], 5) and tumor malignancy (P = .014; HR, 6.7) were prognostic factors for renal function deterioration whereas imperative indication was a risk factor for major postoperative complications (P = .0019; HR, 2.7). In 126 (75%) patients with malignant tumors, after a median follow-up of 30 months (range, 1-254 months), 25 patients (20.2%) died. In multivariate analysis, imperative indication (P = .023; HR, 4.2), positive surgical margin (P = .021; HR, 3.3), and Fuhrman grade > II (P = .013; HR, 3.7) were prognostic indicators for cancer-free survival (CFS). Imperative indication (P = .04; HR, 8.5) and Fuhrman grade > II (P = .04; HR, 3.9) were predictive factors of cancer-specific survival (CSS). In case of elective indication, positive surgical margin, local recurrence, and cancer-related death occurred in 4 (7.6%), 1 (1.1%), and 1 (1.1%) cases, respectively. For elective indication, 5-year estimates of CFS, CSS, and overall survival rates were: 85.7%, 98%, and 93.9%, respectively.
  
  
  CONCLUSIONS
  In this selected population, imperative vs. elective indication status seems to play a critical role in oncologic outcomes. Oncologic results for elective indications are close to those reported with radical nephrectomy.
authors.affiliation: Cancerology Committee of the French Association of Urology (CCAFU), Paris, France; Department of Urology, Angers University Hospital, Angers, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bigot
authors.affiliation: Cancerology Committee of the French Association of Urology (CCAFU), Paris, France; Department of Urology, Clinique Jules Verne, Nantes, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Hétet
authors.affiliation: Cancerology Committee of the French Association of Urology (CCAFU), Paris, France; Department of Urology, Pellegrin University Hospital, Bordeaux, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Bernhard
authors.affiliation: Department of Urology, Pontchaillou University Hospital, Rennes, France.
authors.forename: Tarek
authors.initials: T
authors.lastname: Fardoun
authors.affiliation: Department of Urology, La Pitié Salpetrière University Hospital, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Audenet
authors.affiliation: Paris Descartes University, Cochin Hospital, APHP, Paris, France.
authors.forename: Evanguelos
authors.initials: E
authors.lastname: Xylinas
authors.affiliation: Department of Urology, Saint-Louis University Hospital, APHP, Paris, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Ploussard
authors.affiliation: Cancerology Committee of the French Association of Urology (CCAFU), Paris, France; Department of Urology, Bicêtre University Hospital, Le Kremlin Bicêtre, France.
authors.forename: Géraldine
authors.initials: G
authors.lastname: Pignot
authors.affiliation: Department of Urology, Bicêtre University Hospital, Le Kremlin Bicêtre, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bessede
authors.affiliation: Department of Urology, Bichat University Hospital, APHP, Paris, France.
authors.forename: Idir
authors.initials: I
authors.lastname: Ouzaid
authors.affiliation: Department of Urology, Nantes University Hospital, Nantes, France.
authors.forename: Edouard
authors.initials: E
authors.lastname: Robine
authors.affiliation: Department of Urology, Foch University Hospital, Suresnes, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Brureau
authors.affiliation: Department of Urology, Toulouse University Hospital, Toulouse, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Merigot de Treigny
authors.affiliation: Department of Urology, Bicêtre University Hospital, Le Kremlin Bicêtre, France.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Maurin
authors.affiliation: Cancerology Committee of the French Association of Urology (CCAFU), Paris, France; Department of Urology, Grenoble University Hospital, Grenoble, France.
authors.forename: Jean-Alexandre
authors.initials: JA
authors.lastname: Long
authors.affiliation: Department of Urology, Pellegrin University Hospital, Bordeaux, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Rouffilange
authors.affiliation: Department of Urology, Angers University Hospital, Angers, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Hoarau
authors.affiliation: Department of Urology, Angers University Hospital, Angers, France.
authors.forename: Souhil
authors.initials: S
authors.lastname: Lebdai
authors.affiliation: Cancerology Committee of the French Association of Urology (CCAFU), Paris, France; Department of Urology, La Pitié Salpetrière University Hospital, Paris, France.
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
authors.affiliation: Department of Urology, Saint-Louis University Hospital, APHP, Paris, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Bastien
authors.affiliation: Cancerology Committee of the French Association of Urology (CCAFU), Paris, France; Department of Urology, Foch University Hospital, Suresnes, France.
authors.forename: Yann
authors.initials: Y
authors.lastname: Neuzillet
authors.affiliation: Department of Urology, Saint-Louis University Hospital, APHP, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Mongiat-Artus
authors.affiliation: Department of Urology, Pontchaillou University Hospital, Rennes, France.
authors.forename: Grégory
authors.initials: G
authors.lastname: Verhoest
authors.affiliation: Paris Descartes University, Cochin Hospital, APHP, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Zerbib
authors.affiliation: Department of Urology, Bichat University Hospital, APHP, Paris, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Ravery
authors.affiliation: Cancerology Committee of the French Association of Urology (CCAFU), Paris, France; Department of Urology, Nantes University Hospital, Nantes, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Rigaud
authors.affiliation: Department of Urology, Toulouse University Hospital, Toulouse, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Bellec
authors.affiliation: Cancerology Committee of the French Association of Urology (CCAFU), Paris, France; Department of Urology, Saint-Joseph Hospital, Paris, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Baumert
authors.affiliation: Department of Urology, Angers University Hospital, Angers, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Chautard
authors.affiliation: Cancerology Committee of the French Association of Urology (CCAFU), Paris, France; Department of Urology, Pontchaillou University Hospital, Rennes, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
authors.affiliation: Cancerology Committee of the French Association of Urology (CCAFU), Paris, France; Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Escudier
authors.affiliation: Cancerology Committee of the French Association of Urology (CCAFU), Paris, France; Department of Urology, Lyon Sud University Hospital, Lyon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Paparel
authors.affiliation: Cancerology Committee of the French Association of Urology (CCAFU), Paris, France; Department of Radiology, Pellegrin University Hospital, Bordeaux, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Grenier
authors.affiliation: Cancerology Committee of the French Association of Urology (CCAFU), Paris, France; Department of Pathology, Pontchaillou University Hospital, Rennes, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Rioux-Leclercq
authors.affiliation: Department of Urology, Angers University Hospital, Angers, France.
authors.forename: Abdel-Rahmène
authors.initials: AR
authors.lastname: Azzouzi
authors.affiliation: Cancerology Committee of the French Association of Urology (CCAFU), Paris, France; Department of Urology, Toulouse University Hospital, Toulouse, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Soulié
authors.affiliation: Cancerology Committee of the French Association of Urology (CCAFU), Paris, France; Department of Urology, Bicêtre University Hospital, Le Kremlin Bicêtre, France. Electronic address: jean-jacques.patard@bct.aphp.fr.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Patard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D009392:Nephrectomy / Q000009:adverse effects*; D009399:Nephrons / Q000502:physiology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D012371:Robotics; D013534:Survival; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
keywords: Complications; Functional outcome; Nephron sparing surgery; Oncologic outcome; Renal cell carcinoma; Surgical treatment