title: Functional and oncological outcomes of open nephron-sparing surgery for complex renal masses.
abstract: OBJECTIVE
  To present our long-term functional and oncological outcomes in open nephron-sparing surgery for complex renal masses.
  
  
  METHODS
  We enrolled 584 patients who underwent open partial nephrectomy between January 1995 and May 2014 at our institution; 108 (18.4%) patients had hilar or completely intraparenchymal tumors or both. We compared change in renal function, perioperative complications, and survival outcomes between complex and noncomplex renal masses.
  
  
  RESULTS
  Mean tumor diameter was 4.3 and 3.5cm in patients with hilar and completely intraparenchymal lesions, respectively. R.E.N.A.L. nephrometry scores were significantly higher in patients with complex tumors as compared with patients with exophytic tumors. There was no significant difference between mean estimated glomerular filtration rate at last follow-up compared with preoperative mean estimated glomerular filtration rate in any of the groups. The incidence of perioperative complications was similar across all patients groups. Estimated 10-year cancer-specific survival probabilities were 100% in patients with hilar and intraparenchymal tumors. The 10-year recurrence-free survival probabilities were 96% and 95% in patients with hilar and intraparenchymal tumors, respectively. The main limitations include retrospective design and the lack of kidney-specific functional scan.
  
  
  CONCLUSIONS
  Open nephron-sparing surgery should be considered for complex renal masses yielding excellent functional and oncological outcomes without higher incidence of complications.
authors.affiliation: Bnai-Zion Medical Center, Haifa, Israel; Faculty of Medicine, Technion, Haifa, Israel. Electronic address: Zaher.bahouth@b-zion.org.il.
authors.forename: Zaher
authors.initials: Z
authors.lastname: Bahouth
authors.affiliation: Bnai-Zion Medical Center, Haifa, Israel; Faculty of Medicine, Technion, Haifa, Israel.
authors.forename: Sarel
authors.initials: S
authors.lastname: Halachmi
authors.affiliation: Bnai-Zion Medical Center, Haifa, Israel; Faculty of Medicine, Technion, Haifa, Israel.
authors.forename: Itamar
authors.initials: I
authors.lastname: Getzler
authors.affiliation: Bnai-Zion Medical Center, Haifa, Israel; Faculty of Medicine, Technion, Haifa, Israel.
authors.forename: Orna
authors.initials: O
authors.lastname: Caspin
authors.affiliation: Bnai-Zion Medical Center, Haifa, Israel; Faculty of Medicine, Technion, Haifa, Israel.
authors.forename: Boaz
authors.initials: B
authors.lastname: Moskovitz
authors.affiliation: Bnai-Zion Medical Center, Haifa, Israel; Faculty of Medicine, Technion, Haifa, Israel.
authors.forename: Ofer
authors.initials: O
authors.lastname: Nativ
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Hilar tumor; In situ hypothermia; Intraparenchymal tumor; Nephron-sparing surgery