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ESOU18

ESOU18: The Best Treatment for Renal Masses: T1b in Elderly Patients > 75, Partial Nephrectomy: No

Amsterdam, The Netherlands (UroToday.com) The repeated retrospective comparisons between radical (RN) and partial nephrectomy (PN) series for renal cell carcinoma (RCC) initially indicated the oncological safety of an organ preserving approach for smaller renal lesions up to a diameter of 4 cm (T1a). However, up to date only one prospectively randomized trial [1], that included patients with RCC up to a size of 5 cm, confirmed the comparable therapeutic efficacy of RN versus PN. The EAU guidelines recommend PN for RCCs of stage pT1b whenever it is “technically feasible”. Beyond oncological aspects, the latter recommendation emerged from the assumption that PN versus RN is more suitable to prevent metabolic disorders such as anemia, acidosis or osteoporosis and, in addition, could result in a better preservation of the post-surgical renal function. In PN, each unit eGFR loss contributes to a higher risk of cardiovascular disorders and, in addition, a 3 % decrease in overall survival. 

Following the organ - sparing resection of larger RCCs (≥ stage T1b) the frequency of genitourinary complications can be expected to increase in parallel to the tumor diameter and complexity. Although a substantial number of patients with a preoperative normal renal function experienced a post-surgical GFR decrease below the threshold of 60 ml / min in the prospectively randomized EORTC trial, the overall survival following treatment remained hereby unaffected. The only clearly identifiable advantage of a PN versus a RN for RCC is the avoidance of a surgically induced further GFR loss added to the inherent risk for the development of end stage kidney disease in those patients who present with a preexisting impairment of the renal function. 

Taken together, for RCC patients with a normal preoperative renal function who either reveal significant comorbidities or belong to a higher age group with a proposed threshold of about 75 years, the advantages of a PN versus a RN have to be carefully weighed against the potential therapy - associated morbidity. 


Speaker: Markus A. Kuczyk, MD Department of Urology and Urologic Oncology, Medical School of Hannover, Hannover, Germany

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at The 15th Meeting of the EAU Section of Oncological Urology ESOU18 - January 26-28, 2018 - Amsterdam, The Netherlands

References:

  1. Van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A, Borkowski A, Colombel M, Klotz L, Skinner E, Keane T, Marreaud S, Collette S, Sylvester R. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol. 2011 Apr;59(4):543-52