Oncological and functional outcomes of patients who underwent open partial nephrectomy for kidney tumor
https://doi.org/10.4081/aiua.2023.12130
Accepted: December 2, 2023
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Objective: To report long-term functional and oncological outcomes of OPN Methods: We enrolled 182 patients who underwent consecutive OPN with a diagnosis of kidney tumor in our clinic between April 2002 and February 2020 and were selected from our prospective OPN database. Preoperative demographic and clinical characteristics, intraoperative and pathological results, and patients' postoperative functional and oncological follow-up data were retrospectively analyzed. Overall survival (OS) and disease- free survival (DFS) were evaluated using Kaplan-Meier survival analysis. The time-dependent variation between preoperative and postoperative functional results was statistically analyzed and presented in a graph. Results and limitations: The mean age was 54.4 ± 10.8 yr, and the median age-adjusted Charlson comorbidity index (ACCI) was 1 (interquartile range [IQR] 0-1). The mean tumor size was 3.1 ± 1.2 cm, and the median RENAL score was 6 (IQR 5-8). The most common malign histopathological subtype was clear cell carcinoma with 76.6%, and five cases (3.4%) had positive surgical margins (PSMs). The most common surgical techniques were the retroperitoneal approach (98.9%) and cold ischemia (88.5%). Estimated glomerular filtration rate (eGFR) preservation was 92% (80.8-99.3, IQR), which translates to 32% chronic kidney disease (CKD) upstaging. Acute kidney injury (AKI) was detected in 27 (14.8%) patients according to RIFLE criteria. The intraoperative complication rate was 5.5%, and the postoperative overall complication rate (Clavien-Dindo 1-5) was 30.2%. Major complications (Clavien-Dindo 3-5) were observed in 13 (7.1%) patients. The median oncological follow-up was 42 mo (21.3- 84.6, IQR), and the 5- and 10-yr OS were 90.1% and 78.6%, 5 and 10-yr DFS were 99.4% and 92.1%, respectively. No local recurrence was observed in 5 (3.4%) patients with PSMs; only one had distant metastasis in the 8th postoperative month. The retrospective design, the small number of patients who underwent PN based on mandatory indication, and one type of surgical approach may limit the generalizability of our findings. Conclusions: This study confirms excellent long-term oncologic and functional outcomes after OPN in a cohort of patients selected from a single institution. In light of the information provided by the literature and our study, our recommendation is to push the limits of PN under every technically feasible condition in the treatment of kidney tumors to protect the kidney reserve and achieve near-perfect oncological results.
Ferlay J, Colombet M, Soerjomataram I, Dyba T, Randi G, Bettio M, et al. Cancer incidence and mortality patterns in Europe: Estimates for 40 countries and 25 major cancers in 2018. European journal of cancer. 2018;103:356-87. DOI: https://doi.org/10.1016/j.ejca.2018.07.005
Fergany AF, Hafez KS, Novick AC. Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10-year follow-up. The Journal of urology. 2000;163(2):442-5. DOI: https://doi.org/10.1016/S0022-5347(05)67896-2
Pahernik S, Roos F, Hampel C, Gillitzer R, Melchior SW, Thüroff JW. Nephron sparing surgery for renal cell carcinoma with normal contralateral kidney: 25 years of experience. The Journal of urology. 2006;175(6):2027-31. DOI: https://doi.org/10.1016/S0022-5347(06)00271-0
Patard J-J, Shvarts O, Lam JS, Pantuck AJ, Kim HL, Ficarra V, et al. Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience. The Journal of urology. 2004;171(6 Part 1):2181-5. DOI: https://doi.org/10.1097/01.ju.0000124846.37299.5e
Thompson RH, Boorjian SA, Lohse CM, Leibovich BC, Kwon ED, Cheville JC, et al. Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy. The Journal of urology. 2008;179(2):468-73. DOI: https://doi.org/10.1016/j.juro.2007.09.077
Kaouk JH, Autorino R. Laparoendoscopic single-site surgery (LESS) and nephrectomy: current evidence and future perspectives. Citeseer; 2012. DOI: https://doi.org/10.1016/j.eururo.2012.06.028
Gill IS, Kavoussi LR, Lane BR, Blute ML, Babineau D, Colombo JR, et al. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. The Journal of urology. 2007;178(1):41-6. DOI: https://doi.org/10.1016/j.juro.2007.03.038
Patard J-J, Pantuck AJ, Crepel M, Lam JS, Bellec L, Albouy B, et al. Morbidity and clinical outcome of nephron-sparing surgery in relation to tumour size and indication. European urology. 2007;52(1):148-54. DOI: https://doi.org/10.1016/j.eururo.2007.01.039
Kenney P, Wotkowicz C, Libertino J. Contemporary open surgery of the kidney. Campbell-Walsh Urology. 2012;2:1567-8. DOI: https://doi.org/10.1016/B978-1-4160-6911-9.00054-2
Becker F, Van Poppel H, Hakenberg OW, Stief C, Gill I, Guazzoni G, et al. Assessing the impact of ischaemia time during partial nephrectomy. European urology. 2009;56(4):625-35. DOI: https://doi.org/10.1016/j.eururo.2009.07.016
Ramirez D, Caputo PA, Krishnan J, Zargar H, Kaouk JH. Robot‐assisted partial nephrectomy with intracorporeal renal hypothermia using ice slush: step‐by‐step technique and matched comparison with warm ischaemia. Bju International. 2016;117(3):531-6. DOI: https://doi.org/10.1111/bju.13346
Yossepowitch O, Eggener SE, Serio A, Huang WC, Snyder ME, Vickers AJ, et al. Temporary renal ischemia during nephron sparing surgery is associated with short-term but not long-term impairment in renal function. The Journal of urology. 2006;176(4):1339-43. DOI: https://doi.org/10.1016/j.juro.2006.06.046
You C, Du Y, Wang H, Peng L, Wei T, Zhang X, et al. Laparoscopic Versus Open Partial Nephrectomy: A Systemic Review and Meta-Analysis of Surgical, Oncological, and Functional Outcomes. Frontiers in oncology. 2020;10:2261. DOI: https://doi.org/10.3389/fonc.2020.583979
Tachibana H, Kondo T, Yoshida K, Takagi T, Tanabe K. Lower incidence of postoperative acute kidney injury in robot-assisted partial nephrectomy than in open partial nephrectomy: A propensity score-matched study. Journal of Endourology. 2020. DOI: https://doi.org/10.1089/end.2019.0622
Lerner SE, Hawkins CA, Blute ML, Grabner A, Wollan PC, Eickholt JT, et al. Disease outcome in patients with low stage renal cell carcinoma treated with nephron sparing or radical surgery. The Journal of urology. 1996;155(6):1868-73. DOI: https://doi.org/10.1016/S0022-5347(01)66032-4
Chang KD, Abdel Raheem A, Kim KH, Oh CK, Park SY, Kim YS, et al. Functional and oncological outcomes of open, laparoscopic and robot‐assisted partial nephrectomy: a multicentre comparative matched‐pair analyses with a median of 5 years’ follow‐up. Bju international. 2018;122(4):618-26. DOI: https://doi.org/10.1111/bju.14250
Minervini A, Mari A, Borghesi M, Antonelli A, Bertolo R, Bianchi G, et al. The occurrence of intraoperative complications during partial nephrectomy and their impact on postoperative outcome: results from the RECORd1 project. Minerva urologica e nefrologica= The Italian journal of urology and nephrology. 2018;71(1):47-54. DOI: https://doi.org/10.23736/S0393-2249.18.03202-2
Caraballo ER, Palacios DA, Suk-Ouichai C, Wu J, Dong W, Tanaka H, et al. Open partial nephrectomy when a non-flank approach is required: indications and outcomes. World journal of urology. 2019;37(3):515-22. DOI: https://doi.org/10.1007/s00345-018-2414-4
Capitanio U, Bensalah K, Bex A, Boorjian SA, Bray F, Coleman J, et al. Epidemiology of renal cell carcinoma. European urology. 2019;75(1):74-84. DOI: https://doi.org/10.1016/j.eururo.2018.08.036
Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute renal failure–definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Critical care. 2004;8(4):R204.
Bravi CA, Mari A, Larcher A, Amparore D, Antonelli A, Artibani W, et al. Toward Individualized Approaches to Partial Nephrectomy: Assessing the Correlation Between Ischemia Time and Patient Health Status (RECORD2 Project). European Urology Oncology. 2020. DOI: https://doi.org/10.1016/j.euo.2020.05.009
Porpiglia F, Fiori C, Bertolo R, Angusti T, Piccoli GB, Podio V, et al. The effects of warm ischaemia time on renal function after laparoscopic partial nephrectomy in patients with normal contralateral kidney. World journal of urology. 2012;30(2):257-63. DOI: https://doi.org/10.1007/s00345-011-0729-5
Porpiglia F, Fiori C, Bertolo R, Morra I, Russo R, Piccoli G, et al. Long-term functional evaluation of the treated kidney in a prospective series of patients who underwent laparoscopic partial nephrectomy for small renal tumors. European Urology. 2012;62(1):130-5. DOI: https://doi.org/10.1016/j.eururo.2012.02.001
Valente MA, Hillege HL, Navis G, Voors AA, Dunselman PH, Van Veldhuisen DJ, et al. The Chronic Kidney Disease Epidemiology Collaboration equation outperforms the Modification of Diet in Renal Disease equation for estimating glomerular filtration rate in chronic systolic heart failure. European journal of heart failure. 2014;16(1):86-94. DOI: https://doi.org/10.1093/eurjhf/hft128
Peycelon M, Hupertan V, Comperat E, Renard-Penna R, Vaessen C, Conort P, et al. Long-term outcomes after nephron sparing surgery for renal cell carcinoma larger than 4 cm. The Journal of urology. 2009;181(1):35-41. DOI: https://doi.org/10.1016/j.juro.2008.09.025
Tabayoyong W, Abouassaly R, Kiechle JE, Cherullo EE, Meropol NJ, Shah ND, et al. Variation in surgical margin status by surgical approach among patients undergoing partial nephrectomy for small renal masses. The Journal of urology. 2015;194(6):1548-53. DOI: https://doi.org/10.1016/j.juro.2015.06.076
Yossepowitch O, Thompson RH, Leibovich BC, Eggener SE, Pettus JA, Kwon ED, et al. Positive surgical margins at partial nephrectomy: predictors and oncological outcomes. The Journal of urology. 2008;179(6):2158-63. DOI: https://doi.org/10.1016/j.juro.2008.01.100
Petros FG, Metcalfe MJ, Yu K-J, Keskin SK, Fellman BM, Chang CM, et al. Oncologic outcomes of patients with positive surgical margin after partial nephrectomy: a 25-year single institution experience. World journal of urology. 2018;36(7):1093-101. DOI: https://doi.org/10.1007/s00345-018-2241-7
Bensalah K, Pantuck AJ, Rioux-Leclercq N, Thuret R, Montorsi F, Karakiewicz PI, et al. Positive surgical margin appears to have negligible impact on survival of renal cell carcinomas treated by nephron-sparing surgery. European urology. 2010;57(3):466-73. DOI: https://doi.org/10.1016/j.eururo.2009.03.050
Ani I, Finelli A, Alibhai SM, Timilshina N, Fleshner N, Abouassaly R. Prevalence and impact on survival of positive surgical margins in partial nephrectomy for renal cell carcinoma: a population‐based study. BJU international. 2013;111(8):E300-E5. DOI: https://doi.org/10.1111/j.1464-410X.2012.11675.x
Becker F, Siemer S, Humke U, Hack M, Ziegler M, Stöckle M. Elective nephron sparing surgery should become standard treatment for small unilateral renal cell carcinoma: long-term survival data of 216 patients. European urology. 2006;49(2):308-13. DOI: https://doi.org/10.1016/j.eururo.2005.10.020
Lane BR, Campbell SC, Gill IS. 10-year oncologic outcomes after laparoscopic and open partial nephrectomy. The Journal of urology. 2013;190(1):44-9. DOI: https://doi.org/10.1016/j.juro.2012.12.102
Marszalek M, Meixl H, Polajnar M, Rauchenwald M, Jeschke K, Madersbacher S. Laparoscopic and open partial nephrectomy: a matched-pair comparison of 200 patients. European urology. 2009;55(5):1171-8. DOI: https://doi.org/10.1016/j.eururo.2009.01.042
Copyright (c) 2023 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Downloads
Citations
