Introduction and Objective Nephron-sparing surgery (NSS) is currently bring used for patients with small, localized renal cell carcinoma (RCC) tumors. We reviewed our experience with NSS as a treatment modality of choice for RCC in a contemporaneous cohort (2000-2005) (group 1) (n = 60) and compared surgical outcomes, risk factors for recurrence, and complications to two older UCLA cohorts (1995-1999) (group 2) (n = 211) and (1980-1994) (group 3) (n = 90). The goal was to determine whether increasing the indications for NSS would increase morbidity or compromise surgical outcomes. In addition, each group was compared with a time-matched cohort of radical nephrectomy patients with similar tumor characteristics to compare oncological efficacy and rate of surgical complications.
Results In group 1, 76%, 6.6%, and 17.4% of patients presented with T1, T2, and T3 disease respectively. This was not significantly different from the T stage distribution in the other time cohorts. In addition, no significant difference was found in mean tumor size (group 1 = 4.09 cm), the presence of positive nodes (group 1 = 4.3%) or metastatic disease (18.9%). In addition, no difference was found in tumor multifocality, tumor grade, complication rate, or the use of a drain. Mean length of stay significantly decreased from (group 3 = 7.69 days) to (group 1 = 4.09). Mean blood loss also significantly decreased over time from group 3 = 604.3 mL to group 1 = 425.0. Both of these decreased imply improved surgical technique as NSS became more routine at UCLA. Tumor recurrence and cancer-specific survival were not significantly difference across the time groups for patients that underwent NSS. In comparing the NSS patients with the radical nephrectomy cohort, NSS patients had both significantly less recurrences of RCC (5.8% vs 11.4%; p = .006) and increased mean time until recurrence (143 vs 137 months). In addition the NSS patients had a greater cancer survival rate (98% vs 79%; p < .0001) increased mean time of survival.
Conclusions Improved surgical techniques with better hemostasis and optimized visualization have allowed NSS for larger and more complicated tumors to be performed without increasing morbidity or compromising oncologic efficacy. With longer survival of patients now expected, NSS should be based on this and other series and be considered the gold standard for T1 (≤ 7 cm) tumors rather than radical nephrectomy, which would place patients at future risk for renal insufficiency or hemodialysis.
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