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Article Dans Une Revue Clinical Genitourinary Cancer Année : 2014

Nephron-sparing surgery for renal tumors measuring more than 7 cm: morbidity, and functional and oncological outcomes

Pierre Bigot
  • Fonction : Auteur
Jean-François Hétet
  • Fonction : Auteur
Tarek Fardoun
  • Fonction : Auteur
François Audenet
  • Fonction : Auteur
Guillaume Ploussard
  • Fonction : Auteur
  • PersonId : 760721
  • IdRef : 168065851
Thomas Bessede
  • Fonction : Auteur
Edouard Robine
  • Fonction : Auteur
Laurent Brureau
  • Fonction : Auteur
Olivier Merigot De Treigny
  • Fonction : Auteur
Charlotte Maurin
  • Fonction : Auteur
Jean Rouffilange
  • Fonction : Auteur
Nicolas Hoarau
  • Fonction : Auteur
Souhil Lebdai
  • Fonction : Auteur
Yann Neuzillet
  • Fonction : Auteur
Marc Zerbib
  • Fonction : Auteur

Résumé

BACKGROUND: The purpose of this study was to evaluate morbidity, functional, and oncological outcomes after NSS in renal tumors \textgreater 7 cm. MATERIALS AND METHODS: We retrospectively analyzed data from 168 patients with tumors \textgreater 7 cm who were treated using NSS between 1998 and 2012. RESULTS: Imperative and elective indications accounted for 76 (45.2%) and 92 (54.8%) patients, respectively. Major perioperative complications and renal function deterioration occurred in 33 (19.6%) and 51 patients (30.4%), respectively. In multivariate analysis, age older than 60 years (P = .001; hazard ratio [HR], 5) and tumor malignancy (P = .014; HR, 6.7) were prognostic factors for renal function deterioration whereas imperative indication was a risk factor for major postoperative complications (P = .0019; HR, 2.7). In 126 (75%) patients with malignant tumors, after a median follow-up of 30 months (range, 1-254 months), 25 patients (20.2%) died. In multivariate analysis, imperative indication (P = .023; HR, 4.2), positive surgical margin (P = .021; HR, 3.3), and Fuhrman grade \textgreater II (P = .013; HR, 3.7) were prognostic indicators for cancer-free survival (CFS). Imperative indication (P = .04; HR, 8.5) and Fuhrman grade \textgreater II (P = .04; HR, 3.9) were predictive factors of cancer-specific survival (CSS). In case of elective indication, positive surgical margin, local recurrence, and cancer-related death occurred in 4 (7.6%), 1 (1.1%), and 1 (1.1%) cases, respectively. For elective indication, 5-year estimates of CFS, CSS, and overall survival rates were: 85.7%, 98%, and 93.9%, respectively. CONCLUSION: In this selected population, imperative vs. elective indication status seems to play a critical role in oncologic outcomes. Oncologic results for elective indications are close to those reported with radical nephrectomy.

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Génétique
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Dates et versions

hal-01064296 , version 1 (16-09-2014)

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Citer

Pierre Bigot, Jean-François Hétet, Jean-Christophe Bernhard, Tarek Fardoun, François Audenet, et al.. Nephron-sparing surgery for renal tumors measuring more than 7 cm: morbidity, and functional and oncological outcomes. Clinical Genitourinary Cancer, 2014, 12 (1), pp.e19--27. ⟨10.1016/j.clgc.2013.09.004⟩. ⟨hal-01064296⟩
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