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The evolving role of partial nephrectomy in the management of renal cell carcinoma

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Abstract

The surgical management of renal cell carcinoma has undergone critical review over the past decade. Initially treated with radical nephrectomy, renal cell carcinoma is now approached with nephron-sparing surgical techniques. Improved imaging modalities have substantially increased the number of incidental renal tumors detected, and with the increasing number of incidentally detected kidney tumors, a size and stage migration has occurred in renal cell carcinoma. Early studies showed that disease-free survival rates were similar between cancers treated with radical and partial nephrectomy. The standard now is to offer partial nephrectomy as a surgical option to all patients with renal lesions measuring 4.0 cm or smaller in the setting of a normal contralateral kidney. More recent issues regarding partial nephrectomy concern complication rates and management, renal cell carcinoma multifocality, margin status and distance to normal renal parenchyma, cost analysis, and the development of laparoscopic techniques that duplicate open partial nephrectomy. The purpose of this review is to outline and analyze these more recent concerns regarding partial nephrectomy.

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References and Recommended Reading

  1. Jemal A, Thomas A, Murray T, Thun M: Cancer statistics, 2002, CA Cancer J Clin 2002; 52:23–47.

    PubMed  Google Scholar 

  2. Pantuck AJ, Zisman A, Belldegrun AS: The changing natural history of renal cell carcinoma, J Urol 2001, 166:1611–1623.

    Article  PubMed  CAS  Google Scholar 

  3. Chow WH, Devesa SS, Warren JL, et al.: Rising incidence of renal cell carcinoma in the United States, JAMA 1999, 281:1628–1631.

    Article  PubMed  CAS  Google Scholar 

  4. Novick AC, Campbell SC: Renal tumors. InCampbell’s Urology, edn 8. Edited by Campbell Walsh PC, Retik, AB. Philadelphia: WB Saunders; 2002:2672–2731.

    Google Scholar 

  5. VermootenV: Indications for conservative surgery in certain renal tumors: a study based on growth pattern of the clear cell carcinoma. J Urol 1950, 64:200–202.

    PubMed  CAS  Google Scholar 

  6. Robson CJ, Churchill BM, Anderson W: The results of radical nephrectomy for renal cell carcinoma. J Urol 1969, 101:297–301.

    PubMed  CAS  Google Scholar 

  7. Uzzo RG, Novick AC: Nephron sparing surgery for renal tumors: indications, techniques and outcomes. J Urol 2001, 166:6–18.

    Article  PubMed  CAS  Google Scholar 

  8. Hafez KS, Fergany AF, Novick AC: Nephron-sparing surgery for localized renal cell carcinoma: impact of size on patient survival, tumor recurrence and TNM staging. J Urol 1999, 162:1930–1933. This key study analyzed recurrence and progression rates in tumors of different size categories and defined 4 cm as a cutoff point.

    Article  PubMed  CAS  Google Scholar 

  9. Lerner SE, Hawkins CA, Blute ML, et al.: Disease outcome in patients with low stage renal cell carcinoma treated with nephron sparing or radical surgery. J Urol 1996, 155:1868–1873.

    Article  PubMed  CAS  Google Scholar 

  10. Lee CT, Katz J, Shi W, et al.: Surgical management of renal tumors 4 cm or less in a contemporary cohort. J Urol 2000, 163:730–736.

    Article  PubMed  CAS  Google Scholar 

  11. Grabstald H, Aviles E: Renal cell cancer in the solitary kidney or sole-functioning kidney. Cancer 1968, 22:973–987.

    Article  PubMed  CAS  Google Scholar 

  12. Schiff M Jr, Bagley DH, Lytton B: Treatment of solitary and bilateral renal carcinomas. J Urol 1979, 121:581–586.

    PubMed  Google Scholar 

  13. Novick AC, Streem S, Montie JE, et al.: Conservative surgery for renal cell carcinoma: a single-center experience with 100 patients. J Urol 1989, 141:835–839.

    PubMed  CAS  Google Scholar 

  14. Fergany AF, Hafez KS, Novick AC: Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10-year followup. J Urol 2000, 163:442–445. This study presents 10-year follow-up data. The investigators at CCF reported a 5-year cancer-specific survival rate of 88.2% and a 10-year cancer-specific survival rate of 73%. These findings established NSS as a reasonable approach to clinically localized RCC for tumors 4 cm and smaller.

    Article  PubMed  CAS  Google Scholar 

  15. Licht MR, Novick AC: Nephron sparing surgery for renal cell carcinoma. J Urol 1993, 149:1–7.

    PubMed  CAS  Google Scholar 

  16. Wunderlich H, Schlichter A, Zermann DH, et al.: Multifocality in renal cell carcinoma: a bilateral event? Urol Int 1999, 63:160–163.

    Article  PubMed  CAS  Google Scholar 

  17. Cheng WS, Farrow GM, Zincke H: The incidence of multicentricity in renal cell carcinoma. J Urol 1991, 146:1221–1223.

    PubMed  CAS  Google Scholar 

  18. Whang M, O’Toole K, Bixon R, et al.: The incidence of multifocal renal cell carcinoma in patients who are candidates for partial nephrectomy. J Urol 1995, 154:9680150971.

    Article  Google Scholar 

  19. Novick AC, Gephardt G, Guz B, et al.: Long-term follow-up after partial removal of a solitary kidney. N Engl J Med 1991, 325:1058–1062.

    Article  PubMed  CAS  Google Scholar 

  20. Butler BP, Novick AC, Miller DP, et al.: Management of small unilateral renal cell carcinomas: radical vs. nephron-sparing surgery. Urology 1995, 45:34–41.

    Article  PubMed  CAS  Google Scholar 

  21. Lau WK, Blute ML, Weaver AL, et al.: Matched comparison of radical nephrectomy vs. nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin Proc 2000, 75:1236–1242.

    Article  PubMed  CAS  Google Scholar 

  22. McKiernan J, Simmons R, Katz J, Russo P: Natural history of chronic renal insufficiency after partial and radical nephrectomy. Urology 2002, 59:816–820. This study showed a significant difference in serum creatinine levels between patients treated with partial and radical nephrectomy, indicating that patients undergoing radical nephrectomy for RCC are at a much greater risk for developing chronic renal insufficiency compared with those treated with partial nephrectomy.

    Article  PubMed  Google Scholar 

  23. Piper NY, Bishoff JT, Magee C, et al.: Is a 1-cm margin necessary during nephron-sparing surgery for renal cell carcinoma? Urology 2001, 58:849–852.

    Article  PubMed  CAS  Google Scholar 

  24. Sutherland SE, Resnick MI, Maclennan GT, Goldman HB: Does the size of the surgical margin in partial nephrectomy for renal cell cancer really matter? J Urol 2002, 167:61–64. During the first decade of NSS, the adequacy of margin distance to normal renal parenchyma was not assessed. This study suggests that a minimal margin of normal tissue should surround the tumor.

    Article  PubMed  Google Scholar 

  25. Clayman RV, Kavoussi LR, Soper NJ, et al.: Laparoscopic nephrectomy: initial case report. J Urol 1991, 146:278–282.

    PubMed  CAS  Google Scholar 

  26. Gill IS, Desai MM, Kaouk JH, et al.: Laparoscopic partial nephrectomy for renal tumor: duplicating open surgical techniques. J Urol 2002, 167:469–475. These authors describe a laparoscopic technique that duplicates open partial nephrectomy, but long-term data are not currently available for these patients. This report is encouraging because it indicates that the benefits of partial nephrectomy and laparoscopic surgery may be available to patients in the future. However, use of this surgical approach in the general urology practice may be limited because it requires specialized training, skills, and technical support.

    Article  PubMed  Google Scholar 

  27. Uzzo RG, Wei JT, Hafez R, Novick AC: Comparison of direct hospital costs and length of stay for radical nephrectomy versus nephron-sparing surgery in the management of localized renal cell carcinoma. Urology 1999, 54:994–998.

    Article  PubMed  CAS  Google Scholar 

  28. McKiernan JM, Simmons R, Russo P: Renal cortical tumors: When is kidney-sparing surgery the standard of care? Contemp Urol 2002, 14:48–62.

    Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Columbia-Presbyterian Medical Center, 161 Fort Washington Avenue, Atchley Pavilion, 11th floor, 10032, New York, NY, USA

    James M. McKiernan MD

Authors
  1. Scott M. Gilbert MD
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  2. Paul Russo MD
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  3. Mitchell C. Benson MD
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  4. Carl A. Olsson MD
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  5. James M. McKiernan MD
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Gilbert, S.M., Russo, P., Benson, M.C. et al. The evolving role of partial nephrectomy in the management of renal cell carcinoma. Curr Oncol Rep 5, 239–244 (2003). https://doi.org/10.1007/s11912-003-0116-5

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  • DOI: https://doi.org/10.1007/s11912-003-0116-5

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