Partial nephrectomy (PN) for clinical stage T3 tumors is controversial. Radical nephrectomy (RN) has been associated with a greater rate of chronic kidney disease, an increased risk of cardiovascular disease, and increased mortality compared with PN. We present our long-term 2-center experience with PN for stage pT3a tumors and compare the oncologic outcomes with those of similar patients treated with RN.
We reviewed the data from all patients who had undergone nephrectomy for renal cell carcinoma from 1987 to 2015 in 2 medical centers. The study included 134 patients with pathologic stage T3a tumors, of whom 48 and 86 underwent PN and RN, respectively. We compared the 2 groups (PN and RN) using univariate and multivariate analyses.
The tumors of all patients with pathologic stage T3a who had undergone PN had been pathologically upstaged from clinical stage T1 or T2. Univariate and multivariate analyses revealed tumor size was significantly different statistically between the study groups (median, 7.0 cm in RN group vs. 4.0 cm in PN group; P < .001). Surgery type was not a predictor of local recurrence (P = .978), metastatic progression (P = .972), death from renal cancer (P = .626), or death from all causes (P = .974) at the 5-year follow-up point.
The results of the present study have shown similar oncologic outcomes between 48 patients with stage pT3a renal cancer who underwent PN and 86 patients who underwent RN. Although PN was not performed on clinical T3a tumors, our findings suggest that PN can also be considered for these tumors and, thus, avoid the long-term complications of RN. However, strict follow-up protocols are mandatory.
Clinical genitourinary cancer. 2017 Nov 07 [Epub ahead of print]
Asaf Shvero, Ofer Nativ, Yasmin Abu-Ghanem, Dorit Zilberman, Bahouth Zaher, Max Levitt, Eddie Fridman, Orith Portnoy, Jacob Ramon, Zohar A Dotan
Department of Urology, Sheba Medical Center, Tel Hashomer, affiliated with Tel Aviv University, Tel Aviv, Israel. Electronic address: ., Department of Urology, Bnai Zion Medical Center, and Technion-Israel Institute of Technology, Haifa, Israel., Department of Urology, Sheba Medical Center, Tel Hashomer, affiliated with Tel Aviv University, Tel Aviv, Israel., Department of Urology, Tel Hashomer, affiliated with Tel Aviv University, Tel Aviv, Israel., Department of Pathology, Tel Hashomer, affiliated with Tel Aviv University, Tel Aviv, Israel., Department of Radiology, Sheba Medical Center, Tel Hashomer, affiliated with Tel Aviv University, Tel Aviv, Israel.