title: Simple enucleation for the treatment of highly complex renal tumors: Perioperative, functional and oncological results.
abstract: OBJECTIVE
  To assess the role of simple enucleation (SE) for the treatment of highly complex renal tumors.
  
  
  METHODS
  Overall, 96 Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) classification score 10 to 13 renal tumors were treated with SE at our institution. All conventional perioperative variables, surgical, functional and oncological results were gathered in a prospectively maintained database. Survival curves were generated using a Kaplan-Meier method. Univariate analysis assessed the outcome differences.
  
  
  RESULTS
  Mean (± 1s.d.) clinical tumor diameter was 4.8 (± 1.6 cm). 70.8% of patients had ≥ cT1b stage. The PADUA score was recorded as 10, 11, 12 and 13 in 57.3%, 29.2%, 11.5%, and 2.1% of tumors respectively. Overall, 76 patients were treated with an open approach and 20 robotically. Mean warm ischemia time (WIT) was 19.2 min, and WIT greater than 25 min occurred in 14.6% of cases. Positive surgical margin (PSM) rate was 3.6% and trifecta was achieved in 64.3% of patients. Postoperative surgical complications occurred in 24% of patients, with 14.6% Clavien-Dindo grade 1-2, 8.3% grade 3, and 1% grade 4. Five-year cancer specific survival (CSS), recurrent free survival (RFS), and overall survival (OS) rates resulted 96.1%, 90.8% and 88.0%, respectively. Overall, 4.2% of patients experienced progressive disease. At follow-up, the mean decrease of eGFR from preoperative value was 13.9 ml/min. This was not significantly correlated with PADUA score (p = 0.69). The surgical approach was neither a predictor of Trifecta outcome, nor of postoperative complications, WIT > 25 min or PSM rate.
  
  
  CONCLUSIONS
  SE is an effective treatment for highly-complex renal tumors, with a potential key role to widen the NSS (nephron sparing surgery) indications according to guidelines.
authors.affiliation: Department of Urology, Careggi Hospital, University of Florence, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Serni
authors.affiliation: Department of Urology, Careggi Hospital, University of Florence, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Vittori
authors.affiliation: Department of Urology, Careggi Hospital, University of Florence, Italy.
authors.forename: J
authors.initials: J
authors.lastname: Frizzi
authors.affiliation: Department of Urology, Careggi Hospital, University of Florence, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Mari
authors.affiliation: Department of Urology, Careggi Hospital, University of Florence, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Siena
authors.affiliation: Department of Urology, Careggi Hospital, University of Florence, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Lapini
authors.affiliation: Department of Urology, Careggi Hospital, University of Florence, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Carini
authors.affiliation: Department of Urology, Careggi Hospital, University of Florence, Italy. Electronic address: andreamine@libero.it.
authors.forename: A
authors.initials: A
authors.lastname: Minervini
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000503:physiopathology / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D009399:Nephrons; D059351:Organ Sparing Treatments / Q000379:methods*; D059035:Perioperative Period; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012371:Robotics; D013154:Spleen / Q000293:injuries; D013156:Splenectomy; D016896:Treatment Outcome
keywords: Nephrometry; Nephron sparing; Partial nephrectomy; Renal cancer; Simple enucleation