title: Nephron-sparing surgery is superior to radical nephrectomy in preserving renal function benefit even when expanding indications beyond the traditional 4-cm cutoff.
abstract: OBJECTIVE
  To analyze to what extent partial nephrectomy (PN) is superior to radical nephrectomy (RN) in preserving renal function outcome in relation to tumor size indication.
  
  
  METHODS
  Clinical data from 973 patients operated at 9 academic institutions were retrospectively analyzed. Glomerular filtration rate (GFR) before and after surgery was calculated with the abbreviated Modification of the Diet in Renal Disease equation. For a fair comparison between the 2 techniques, all imperative indications for PN were excluded. A shift to a less favorable GFR group following surgery was considered clinically significant.
  
  
  RESULTS
  Median age at diagnosis was 60 years (19-91). Tumor size was smaller than 4 cm in 665 (68.3%) cases and larger than 4 cm in 308 (31.7%) cases. PN and RN were performed in 663 (68.1%) and 310 (31.9%) patients, respectively. In univariate analysis, patients undergoing PN had a smaller risk for developing significant GFR change following surgery than those undergoing RN did. This was true for tumors≤4 cm (P = 0.0001) and for tumors>4 cm (P = 0.0001). In multivariate analysis, the following criteria were independent predictive factors for developing significant postoperative GFR loss: the use of RN (P = 0.0001), preoperative GFR<60 ml/min (P = 0.0001), tumor size≥4 cm (P = 0.0001), and older age at diagnosis (P = 0.0001).
  
  
  CONCLUSIONS
  The renal function benefit carried out by elective PN over RN persists even when expanding nephron-sparing surgery indications beyond the traditional 4-cm cutoff.
authors.affiliation: Department of Urology, Bicetre Hospital, Paris XI University, Le Kremlin Bicêtre, France. Electronic address: geraldine.pignot@bct.aphp.fr.
authors.forename: Géraldine
authors.initials: G
authors.lastname: Pignot
authors.affiliation: Department of Urology, Angers University Hospital, Angers, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bigot
authors.affiliation: Department of Urology, Pellegrin Hospital, Bordeaux University, Bordeaux, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Bernhard
authors.affiliation: Department of Urology, Bicetre Hospital, Paris XI University, Le Kremlin Bicêtre, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Bouliere
authors.affiliation: Department of Urology, Bicetre Hospital, Paris XI University, Le Kremlin Bicêtre, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bessede
authors.affiliation: Department of Urology, Pontchaillou Hospital, Rennes University, Rennes, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
authors.affiliation: Department of Urology, Henri Mondor Hospital, Paris XII University, Créteil, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Salomon
authors.affiliation: Department of Urology, Saint-Etienne University Hospital, Saint-Etienne, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Mottet
authors.affiliation: Department of Urology, Rangueil Hospital, Toulouse University, Toulouse, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Bellec
authors.affiliation: Department of Urology, Rangueil Hospital, Toulouse University, Toulouse, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Soulié
authors.affiliation: Department of Urology, Pellegrin Hospital, Bordeaux University, Bordeaux, France.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Ferrière
authors.affiliation: Department of Urology, Rouen University Hospital, Rouen, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Pfister
authors.affiliation: Department of Urology, Bicetre Hospital, Paris XI University, Le Kremlin Bicêtre, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Drai
authors.affiliation: Department of Urology, Edouard Herriot Hospital, Lyon University, Lyon, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Colombel
authors.affiliation: Department of Urology, Huriez Hospital, Lille Nord de France University, Lille, France.
authors.forename: Arnauld
authors.initials: A
authors.lastname: Villers
authors.affiliation: Department of Urology, Hôtel Dieu Hospital, Nantes University, Nantes, France.
authors.forename: Jerome
authors.initials: J
authors.lastname: Rigaud
authors.affiliation: Department of Urology, Hôtel Dieu Hospital, Nantes University, Nantes, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Bouchot
authors.affiliation: Department of Urology, Vita-Salute University San Raffaele, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: Department of Urology, Vita-Salute University San Raffaele, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bertini
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA.
authors.forename: Arie S
authors.initials: AS
authors.lastname: Belldegrun
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA.
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Pantuck
authors.affiliation: Department of Urology, Bicetre Hospital, Paris XI University, Le Kremlin Bicêtre, France.
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 / Q000601:surgery*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons / Q000601:surgery; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D055815:Young Adult
keywords: Chronic renal disease; Glomerular filtration rate; Partial nephrectomy; Renal cell carcinoma; Renal function; Survival