Abstract
Objectives. To document the feasibility of nephron-sparing surgery (NSS) for the surgical treatment of renal masses measuring larger than 7 cm (cT2) on preoperative imaging. Methods. A total of 139 patients have undergone NSS between 2001 and 2012 by a single surgeon in our clinic. Of these, we identified 17 patients whose tumors were measuring greater than 7 cm on preoperative imaging studies and were limited to the kidney. Their charts were retrospectively reviewed. Results. Mean age of the study population was 49.8 ± 11.3 years. Thirteen patients were managed by open NSS, while 4 patients have undergone robot-assisted NSS. Mean diameter and mean R.E.N.A.L. score of the tumors that were enucleoresected were 8.2 cm and 8.5, respectively. A total of 5 Clavien grade 2 and higher complications were recorded within 30 days of surgery. Histopathologic examination revealed benign histology in almost 1/4 of the cases. After a median followup of 33 months, all of our patients were alive. Only one patient (5.8%) experienced local recurrence. Conclusions. NSS is a feasible and safe option for large (>7 cm) renal masses. It may be considered not only for imperative conditions but also for highly selected cases with a normal contralateral kidney.
Highlights
Nephron-sparing surgery (NSS) offers equivalent oncologic control, as does radical nephrectomy in patients with appropriately selected stage T1 renal tumors [1, 2]
NSS has been associated with decreased risks for renal impairment [3,4,5] and cardiovascular events [6, 7], which may explain the improved overall survival, documented in partial nephrectomy series [8]
We retrospectively reviewed the charts of the patients, whose renal tumors measured more than 7 cm in diameter on preoperative imaging (n = 17, 17.52%)
Summary
Nephron-sparing surgery (NSS) offers equivalent oncologic control, as does radical nephrectomy in patients with appropriately selected stage T1 renal tumors [1, 2]. NSS has been associated with decreased risks for renal impairment [3,4,5] and cardiovascular events [6, 7], which may explain the improved overall survival, documented in partial nephrectomy series [8]. Current guidelines emphasize NSS for all anatomically amenable T1 renal tumors [9]. In order to establish standards for future comparisons, we must fully appreciate the efficacy, safety, and limitations of NSS for renal masses larger than 7 cm. We reviewed our experience and reported the results in 17 patients with renal masses, which had a maximum diameter of more than 7 cm on preoperative imaging studies, treated with either open or robot-assisted laparoscopic NSS during 13 years
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