Partial Nephrectomy For Renal Cancer Research Articles

Comparing Perioperative Complications of Off-Clamp versus On-Clamp Partial Nephrectomy for Renal Cancer Using a Novel Energy Balancing Weights Method.

Partial nephrectomy (PN) is the primary surgical method for renal tumor treatment, typically involving clamping the renal artery during tumor removal, leading to warm ischemia and potential renal function impairment. Off-clamp approaches have been explored to mitigate organ damage, yet few results have emerged about the possible effects on hemoglobin loss. Most evidence comes from retrospective studies using propensity score matching, known to be sensitive to PS model misspecification. The energy balancing weights (EBW) method offers an alternative method to address bias by focusing on balancing all the characteristics of covariate distribution. We aimed to compare on- vs. off-clamp techniques in PN using EB-weighted retrospective patient data. Out of 333 consecutive PNs (275/58 on/off-clamp ratio), the EBW method achieved balanced variables, notably tumor anatomy and staging. No significant differences were observed in the operative endpoints between on- and off-clamp techniques, although off-clamp PNs showed slight reductions in hemoglobin loss and renal function decline, albeit with slightly higher perioperative blood loss. Our findings support previous evidence, indicating comparable surgical outcomes between standard and off-clamp procedures, with the EBW method proving effective in balancing baseline variables in observational studies comparing interventions.

Transperitoneal Laparoscopic and Robotic Partial Nephrectomy for Renal Cancer in Patients with Previous Abdominal Surgery: a Single Centre Experience

Patients with previous abdominal surgery are at an increased risk of peritoneal adhesions, which may complicate transperitoneal surgery. The objective of this article is to report single centre experience with transperitoneal laparoscopic and robotic partial nephrectomy for renal cancer in patients with previous abdominal surgery. We evaluated data from 128 patients who underwent laparoscopic or robotic partial nephrectomy from January 2010 to May 2020. Patients were divided into three groups according to the localization of main previous surgery: in the upper contralateral abdominal quadrant, in the upper ipsilateral abdominal quadrant or in the middle line, in lower abdominal quadrants. Each group was divided into two subgroups (laparoscopic/robotic partial nephrectomy). We separately analysed data of indocyanine green-enhanced robotic partial nephrectomy. Our study did not find significant difference in the rate of intraoperative or postoperative complications between any of the groups. The type of partial nephrectomy (robotic or laparoscopic) affected the surgery time, blood loss, and length of stay in hospital, but did not significantly influence the frequency of complications. Partial nephrectomy in group of patients with prior renal surgery led to a higher rate of intraoperative low-grade complications. We did not observe more favourable results for indocyanine green-enhanced robotic partial nephrectomy. The location of previous abdominal surgery does not influence the rate of intraoperative or postoperative complications. The type of partial nephrectomy (robotic or laparoscopic) does not affect the frequency of complications.

Robotic partial nephrectomy for renal cancer

Introduction: Improved methods are being sought so that the existing low efficiencies can be dealt with for a better solution to the problem of renal cancer. The most promising method is robotic partial nephrectomy which uses a system of automated machines in the treatment of small renal masses as it shows reduced mortality, morbidity, and hospital stay. Aim: To systematically analyze articles to learn about robotic partial nephrectomy and how it has solved some of the current issues in the treatment of renal cancer. Materials and methods: The article systematically reviews 20 articles in the development of a literature review on the emerging technology of robotic partial nephrectomy. The articles are recent and have been published in the last five years. Results and outcome: The studies show the use of robotic partial nephrectomy produces better outcomes in terms of reduced mortality, morbidity, and the number of days a patient stayed in hospital after an operation. Conclusion: The use of robotic partial nephrectomy is the ideal treatment for patients that have renal cancer as it has better outcomes in almost all the researched areas.

Robotic partial nephrectomy for renal cancer

Robotic partial nephrectomy for renal cancer

Why is it worth testing the ability of zinc to protect against ischaemia reperfusion injury for human application.

Ischaemia (interruption in the blood/oxygen supply) and subsequent damage induced by reperfusion (restoration of blood/oxygen supply) ultimately leads to cell death, tissue injury and permanent organ dysfunction. The impact of ischaemia reperfusion injury (IRI) is not limited to heart attack and stroke but can be extended to patients undergoing surgeries such as partial nephrectomy for renal cancer, liver resection for colorectal cancer liver metastasis, cardiopulmonary bypass, and organ transplantation. Unfortunately, there are no drugs that can protect organs against the inevitable peril of IRI. Recent data show that a protocol incorporating specific Zn formulation, dosage, number of dosages, time of injection, and mode of Zn delivery (intravenous) and testing of efficacy in a large preclinical sheep model of IRI strongly supports human trials of Zn preconditioning. No doubt, scepticism still exists among funding bodies and research fraternity on whether Zn, a naturally occurring metal, will work where everything else has failed. Therefore, in this article, we review the conflicting evidence on the promoter and protector role of Zn in the case of IRI and highlight factors that may help explain the contradictory evidence. Finally, we review the literature related to the knowledge of Zn's mechanism of action on ROS generation, apoptosis, HIF activation, inflammation, and signal transduction pathways, which highlight Zn's likelihood of success compared to various other interventions targeting IRI.

A Nomogram to Predict Significant Estimated Glomerular Filtration Rate Reduction After Robotic Partial Nephrectomy

BackgroundDecreased functional outcome after partial nephrectomy is associated with overall mortality. ObjectiveTo create a model that predicts ≥25% reduction from baseline estimated glomerular filtration rate (eGFR) in patients undergoing robot-assisted partial nephrectomy (RAPN) and to investigate the role of acute kidney injury (AKI) in this patient population. Design, setting, and participantsA total of 999 patients were identified from a multi-institutional database. Renal function was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines for chronic kidney disease (CKD). AKI was defined as >25% reduction in eGFR from pre-RAPN period to discharge. Outcome measurements and statistical analysisA nomogram to predict significant eGFR reduction (≥25% from baseline) in the time-frame between 3 and 15mo after RAPN was built based on the coefficients of Cox survival function that ultimately included age, sex, Charlson comorbidity index, baseline eGFR, RENAL nephrometry score, AKI in patients with normal baseline renal function, and AKI on CKD. Such landmark analysis was chosen in order to account for eGFR fluctuations occurring within the first 3mo of RAPN. The proportional hazard assumption was evaluated through the Schönfeld test. Internal validation was performed using the leave-one-out cross validation. Calibration was graphically investigated. The decision curve analysis (DCA) was used to evaluate the net clinical benefit. Results and limitationsMedian (interquartile range [IQR]) age at surgery was 61yr (51, 68). Overall, 146 patients experienced significant eGFR reduction; median follow-up for survivors was 12.4mo. The 15-mo probability of significant eGFR reduction was 19%. All variables fitted into the model, including AKI in patients with normal renal function (hazard ratio [HR]: 4.51; 95% confidence interval [CI]: 3.12, 6.60; p<0.001) and AKI on CKD (HR: 4.90; 95% CI: 2.17, 11.1; p<0.001), emerged as predictors of significant eGFR reduction (all p≤0.048) and were considered to build a nomogram. The internally validated c index was 73%. The model demonstrated excellent calibration and a net benefit at the DCA with probabilities ≥4%. ConclusionsWe developed a nomogram that accurately predicts significant eGFR reduction after RAPN. This model may serve as a tool for early identification of patients at high risk for significant renal function decline after surgery. Patient summaryWe have developed a model for the prediction of renal function loss after partial nephrectomy for renal cancer.

Validation of radius exophytic/endophytic nearness anterior/posterior location and preoperative aspects and dimensions used for an anatomical nephrometric scores in patients undergoing partial nephrectomy for renal cancer: A single-center experience and literature review.

Introduction:Nephrometric scores are used to predict perioperative and postoperative complications, with no uniform results in the current literature.Materials and Methods:A retrospective study of 141 patients in a single center who underwent open partial nephrectomy between June 2006 and 2016 for T1a and T1b renal tumor was conducted. Univariate and multivariate analyses were used to evaluate the correlations between preoperative aspects and dimensions used for an anatomical (PADUA) and radius exophytic/endophytic nearness anterior/posterior location (RENAL) scores and their components with pre-, peri-, and post-operative parameters. Linear regression (F-tests) and logical regression models were used to test for significance of the association and predictability of outcomes.Results:Total RENAL score (P = 0.032), its components R (P = 0.004), E (P = 0.022), L (P = 0.011), and total PADUA score (P = 0.016) were significantly associated with ischemic time. In postoperative complications, the PADUA components: sinus line location (P = 0.008), lateral/medial rim score (P = 0.029), and collecting system score (P = 0.006) showed significance. None of the variables showed correlation with operation time and change in estimated glomerular filtration rate (eGFR). On multivariate analysis, sinus line location and gender (P = 0.012) showed significance in predicting eGFR changes and RENAL score component: A (P = 0.049) was significant in predicting estimated blood loss. Both RENAL and PADUA components were significantly associated with hospital length of stay.Conclusion:Both RENAL and PADUA scores showed important correlation in predicting outcomes. We further demonstrated the importance of knowing the individual components of the scores, which can independently give outcome predictions. The scoring systems can still be improved and standardized for broad clinical use with larger cohort and multicenter-based studies.

Feasibility of Contrast-Enhanced Intraoperative Ultrasound for Detection and Characterization of Renal Mass Undergoing Open Partial Nephrectomy.

To determine the feasibility of obtaining intraoperative contrast-enhanced ultrasound (CEUS) imaging in patients undergoing open partial nephrectomy for renal cancer. We hypothesize that the study was feasible and the addition of CEUS would improve lesion identification and characterization. The study population consisted of 10 patients with known renal mass scheduled for intraoperative ultrasound-guided open partial nephrectomy. After dissection and exposure of the kidney by the surgeon, an intraoperative pre- and post-CEUS was performed by the radiologist. Feasibility was defined as successful imaging in 8 of 10 patients with intraoperative CEUS. Image quality, lesion conspicuity/contrast, lesion vascularity, morphology, and size were assessed and graded with pre- and post-contrast images. Intraoperative ultrasound was successfully acquired in 10 of 11 patients for renal mass detection and characterization. One study was canceled intraoperatively as a result of clinical complications related to a difficult surgery. Tumor size ranged from 1.3 to 4.2 cm. All lesions were solid. No additional lesions were found on CEUS compared with baseline imaging. Image quality post-contrast ranged from acceptable to excellent. There were no adverse events recorded for all 10 patients. In our feasibility study consisting of 10 patients, CEUS for detection and characterization of renal mass undergoing open partial nephrectomy was feasible and safe. Because intraoperative ultrasound during open partial nephrectomy can affect the extent of surgery, CEUS can be used to help detect and characterize renal mass for surgical planning/resection intraoperatively.

Long-Term Oncological and Functional Outcomes of Partial Nephrectomy in Solitary Kidneys

BackgroundIn this study we assessed the efficacy of nephron-sparing surgery and the changes in renal function after surgery in patients with solitary kidneys. Patients and MethodsFrom January 2000 to January 2015, 50 patients with solitary kidneys underwent partial nephrectomy for renal cancer. In 34 of the patients the contralateral kidneys had been removed previously because of renal tumor. The mean age of the patients was 62 ± 10 years. There were 15 women and 35 men. ResultsThe average diameter of the tumors was 35.2 ± 19.5 mm. The mean preoperative aspects and dimensions used for an anatomical classification score was 7.6 ± 0.7. The mean renal ischemia time was 13.8 ± 6.5 minutes. The mean preoperative and the early postoperative glomerular filtration rate (GFR) were 62 ± 21 mL/min/1.73 m2 and 44 ± 18 mL/min/1.73 m2 (P = .0001), respectively. The mean GFR values decreased by 29% at 1 and at 3 years, and by 36% at 5 years after surgery. All changes in postoperative GFR levels were significant compared with the preoperative values. The tumor size and the warm ischemia time were risk factors for the long-term renal function. The mean follow-up time was 106 ± 96 months. During this period local recurrence occurred in 1 patient, and distant metastases were diagnosed in 4 cases. The 5-year overall, disease-specific, and recurrence-free survival were 88%, 93%, and 88%, respectively. ConclusionPartial nephrectomy provides a good oncological outcome. However, after nephron-sparing surgery most patients develop chronic renal disease, although hemodialysis treatment is rarely necessary. The tumor size and the warm ischemia time showed a close correlation with the long-term renal function.

Mannitol has no impact on renal function after open partial nephrectomy in solitary kidneys

Mannitol has been administered during partial nephrectomy as a renal protective agent for ischemic damage. However, we do not have any high-level clinical evidence of its effectiveness. The aim of the present study was to evaluate the effect of mannitol during open partial nephrectomy by comparing the postoperative renal function of patients who received it and those who did not. We retrospectively reviewed the records of 55 patients who underwent open partial nephrectomy for renal cancer in a solitary kidney from January 1990 to December 2012, and who were followed up postoperatively for at least 6 months. Of the 55 patients, mannitol was given to 20 patients (group M+) and not to the other 35 patients (group M-). We compared not only the postoperative estimated glomerular filtration rate, but also its decrease rate and the incidence of acute kidney injury requiring dialysis in the two groups. There were no significant differences in perioperative patient characteristics between the two groups. Mannitol made no significant difference in both the postoperative estimated glomerular filtration rate and its decrease rate at any point within 6 months of the postoperative period. The incidence of acute kidney injury requiring dialysis was one (5.0%) in group M+ and two (5.7%) in group M-. These findings suggest that there might be no advantage from the administration of mannitol during open partial nephrectomy.

Evidence of a heterogeneous tissue oxygenation: renal ischemia/reperfusion injury in a large animal model

Renal ischemia that occurs intraoperatively during procedures requiring clamping of the renal artery (such as renal procurement for transplantation and partial nephrectomy for renal cancer) is known to have a significant impact on the viability of that kidney. To better understand the dynamics of intraoperative renal ischemia and recovery of renal oxygenation during reperfusion, a visible reflectance imaging system (VRIS) was developed to measure renal oxygenation during renal artery clamping in both cooled and warm porcine kidneys. For all kidneys, normothermic and hypothermic, visible reflectance imaging demonstrated a spatially distinct decrease in the relative oxy-hemoglobin concentration (%HbO₂) of the superior pole of the kidney compared to the middle or inferior pole. Mean relative oxy-hemoglobin concentrations decrease more significantly during ischemia for normothermic kidneys compared to hypothermic kidneys. VRIS may be broadly applicable to provide an indicator of organ ischemia during open and laparoscopic procedures.

V1 Clampless laparoendoscopic single-site partial nephrectomy for renal cancer with low PADUA score: Technique and surgical outcomes

V1 Clampless laparoendoscopic single-site partial nephrectomy for renal cancer with low PADUA score: Technique and surgical outcomes

Clampless laparoendoscopic single‐site partial nephrectomy for renal cancer with low PADUA score: technique and surgical outcomes

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Laparoendoscopic single-site (LESS) surgery has proved to be immediately applicable in the clinical field, being safe and feasible in the hands of experienced laparoscopic surgeons in well-selected patients. All extirpative and reconstructive urological procedures have been described in the literature, but LESS partial nephrectomy (PN) is one of the most complex procedures and few studies have been published on this subject. The study describes a clampless technique for LESS PN, by reducing the blood pressure and increasing the intra-abdominal pressure of the pneumoperitoneum to 20 mmHg, timed to precisely coincide with excision of the tumour. This technique was found to be safe and feasible in the treatment of low-risk T1a RCC. To describe the technique and report the surgical outcomes of clampless laparoendoscopic single-site (LESS) partial nephrectomy (PN) in the treatment of renal cell carcinoma (RCC) with low PADUA score. Clampless LESS PN was performed in 14 patients with cT1a renal tumours. Indications to perform a clampless LESS PN were low-risk, laterally based renal tumours, located away from the renal hilum, with a PADUA score ≤7. Demographic data and peri-operative and postoperative variables were recorded and analysed. Kidney function was evaluated by measuring serum creatinine concentration and estimated glomerular filtration rate (eGFR) pre- and postoperatively and at 6-month follow-up. The median operating time was 120 min and warm ischaemia time was zero in all cases. Only one early complication (Clavien grade 1) was recorded: one patient developed a flank haematoma which it was possible to treat by conservative therapy. Serum creatinine and modification of diet renal disease eGFR were not found to be significantly different pre- and postoperatively and at 6-month follow-up. Definitive pathological results showed 12 pT1a RCCs and two pT1a-chromophobe RCCs. All tumours were removed with negative surgical margins. All patients were satisfied with the cosmetic results. At a median (range) follow-up period of 12 (8-15) months, all patients were alive without evidence of tumour recurrence or port-site metastasis. Clampless LESS PN is a safe and feasible surgical procedure in the treatment of low-risk T1a RCC, with excellent cosmetic results.

The next step in nephron sparing surgery: vascular positioning system.

The goal of being able to better see the vasculature of the organ that the surgeon wants to operate on has been always a crucial factor behind the development of better radiological imaging technologies. In urology nowadays, partial nephrectomy for renal cancer is expanding with more cases done with tumors that, in the past, were unthinkable to be qualified for Nephron Sparing Surgery (NSS). It is because we have better pictures of our radiological studies showing localization of tumors in relation to vessels and calyceal system much clearer [1, 2, 3]. The paper by Drewniak et al. [4] describes the methodology of the elaboration of CD images that can very precisely assess the arterial tree within the kidney, which is sure to make the planning of the surgery easier and can allow the urologist to choose to perform NSS in very complicated cases [5]. We as urologists should always encourage our radiological colleagues to develop and use such applications, especially nowadays when the software development is so rapid. To popularize Dr. Drewniak and colleagues’ work, it may be useful to know whether such technology is available for all radiological centers, if they need anything other than Matlab software and some persistence in using it, or if is it possible to utilize the concept with all CT or MRI images. Of course, it must be taken into account that the majority of renal cell tumors do not need such sophisticated evaluation, which I understand to be rather time–consuming and expensive. We must be aware that the effort to delineate the ninth level ramification of the vessel that is 0.5 mm in size is practically useless; such a vessel does not create any significant problem during the operation. More important are bigger vessels near the tumor, or even quite big ones that may need to be closed in the super selective nephron sparing surgery. I assume that they will be seen very precisely using the presented method. In my opinion, the future of such imaging technology is being able to destroy the renal tumor more precisely and safely without operation but with some form of imaging guided ablation technique. Then such precise mapping of the vascular tree will be of great help in the navigation of the ablation probe. I think that it will happen sooner that we expect.

Determining the best warm ischemic time for patients undergoing partial nephrectomy for renal cancer

The experimental animal study on warm ischemia time (WIT) by Sabbagh and colleagues presents provocative and intriguing results.1 The strength of this study is the use of histologic outcomes as an endpoint for WIT. Using unilateral laparoscopic or open renal artery clamping for various time durations in a porcine model, the authors suggested that no permanent renal histopathologic damage occurred with up to 60 minutes of WIT in the clamped kidney. In addition, they demonstrated that up to 3 hours of pneumoperitoneum caused no histopathologic changes in the non-clamped, contralateral kidney 14 days after surgery. Should we extrapolate these results to humans and be comfortable with WITs of up to 60 minutes in patients undergoing partial nephrectomy for renal cancer? Though the results of this study are attractive, they should be interpreted with caution for several reasons.2 Firstly, physiologic differences are noted between humans and animals, such as unique thrombinolysis kinetics in pigs, that could contribute to disparate WIT outcomes.3 Furthermore, although others have shown that there is little effect on early postoperative renal indicies with up to 90 minutes of WIT in pigs,3 studies examining the effects of WIT beyond 30 minutes in humans are conflicting.4 With regard to the reversible nature of the multifocal interstitial nephritis noted in all kidneys clamped for 5 to 60 minutes, the severity of nephritis was not quantified and the number of animals was low. Moreover, examination of renal tissue on postoperative day 14 may not reflect the true long-term histopathologic consequences of renal ischemia that may surface several months or years after surgery. Without quantitative and long term data, conclusions on whether clamping up to 60 minutes is safe based on early hisptopathology are limited. As pointed out by the authors, renal artery clamping was performed without partial nephrectomy such that the effects of partial nephrectomy on WIT histopathologic outcomes could not be determined.1 The trauma of partial nephrectomy, the worse preoperative renal function in renal cancer patients and the comorbid diseases that commonly coincide with renal cancers could also affect WIT outcomes in the non-experimental setting.5 Lastly, longer duration of renal artery clamping (60 minutes) may cause renal artery scaring and stenosis that may not surface for months and could potentially manifest as hypertensive nephropathy years later. Most of the unanswered questions regarding WIT are not easily controlled for in either experimental or clinical studies. Nonetheless, the results of this study are valuable and hypothesis-generating, but the translation to clinical practice will require human studies. Despite the lines of evidence promoting the safety of WITs beyond 30 minutes, logic dictates that renal artery clamp times should be minimized and balanced with safe tumour extirpation.

Partial nephrectomy for renal cancer (part II): the impact of renal ischaemia, patient preparation, surgical approaches, management of complications and utilization

Partial nephrectomy for renal cancer (part II): the impact of renal ischaemia, patient preparation, surgical approaches, management of complications and utilization

Partial nephrectomy for renal cancer: Part I

BJU InternationalVolume 105, Issue 9 p. 1206-1220 REVIEW ARTICLE Partial nephrectomy for renal cancer: Part I Paul Russo, Paul Russo Department of Surgery, Urology Service, and Weill Medical College, Cornell University, Memorial Sloan Kettering Cancer Center, New York, NY, USASearch for more papers by this author Paul Russo, Paul Russo Department of Surgery, Urology Service, and Weill Medical College, Cornell University, Memorial Sloan Kettering Cancer Center, New York, NY, USASearch for more papers by this author First published: 09 April 2010 https://doi.org/10.1111/j.1464-410X.2010.09339.xCitations: 26 Paul Russo, Department of Surgery, Urology Service, Weill Medical College, Cornell University, 1275 York Avenue, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA.e-mail: russop@mskcc.org Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume105, Issue9May 2010Pages 1206-1220 RelatedInformation

Huge Isolated Port-Site Recurrence after Laparoscopic Partial Nephrectomy: A Case Report

A 66-yr-old man with pain and swelling in the right flank was referred to our clinic for diagnosis. In 2005, the patient underwent a laparoscopic partial nephrectomy for renal cancer of the lower pole of the right kidney. A computed tomography scan revealed a 20-cm tumor in the right abdominal wall, resulting in a suspected diagnosis of port-site metastasis from the first laparoscopic operation. The patient underwent open surgery, which confirmed the diagnosis. After the operation, the patient recovered rapidly.

Open partial nephrectomy in renal cancer: a feasible gold standard technique in all hospitals.

Introduction. Partial nephrectomy (PN) is playing an increasingly important role in localized renal cell carcinoma (RCC) as a true alternative to radical nephrectomy. With the greater experience and expertise of surgical teams, it has become an alternative to radical nephrectomy in young patients when the tumor diameter is 4 cm or less in almost all hospitals since cancer-specific survival outcomes are similar to those obtained with radical nephrectomy. Materials and Methods. The authors comment on their own experience and review the literature, reporting current indications and outcomes including complications. The surgical technique of open partial nephrectomy is outlined. Conclusions. Nowadays, open PN is the gold standard technique to treat small renal masses, and all nonablative techniques must pass the test of time to be compared to PN. It is not ethical for patients to undergo radical surgery just because the urologists involved do not have adequate experience with PN. Patients should be involved in the final treatment decision and, when appropriate, referred to specialized centers with experience in open or laparoscopic partial nephrectomies.

Collecting Duct Renal Cell Carcinoma: A Matched Analysis of 41 Cases

ObjectivesCollecting duct renal cell carcinoma (CDRCC) is a rare but reportedly aggressive histologic subtype. We assessed the stage and histologic features of patients with CDRCC and compared cancer-specific mortality in CDRCC and matched patients with clear-cell renal cell carcinoma (CRCC). MethodsForty-one (0.6%) patients with CDRCC and 5246 CRCC patients were identified within a cohort of 6608 patients treated with either radical or partial nephrectomy for renal cancer. Within the 5246 CRCC cases, 105 were matched with CDRCC cases for grade, tumour size, and T, N, and M stages. Kaplan-Meier and life table analyses addressed RCC-specific survival. ResultsOf all CDRCC patients, 76% had pT3 disease at nephrectomy versus 37% for those with CRCC. The predominant Fuhrman grades were III (56%) and IV (22%) in CDRCC versus II (42%) and III (28%) for CRCC. Moreover, 49% of CDRCC patients were pN1–2 versus 8% for CRCC. Of CDRCC patients 19% had distant metastases at nephrectomy versus 14% for CRCC. Finally, 73% of CDRCC patients had either local or systemic symptoms versus 56% for CRCC. After matching, the RCC-specific mortality of CDRCC patients was no different from that for CRCC patients (RR=1.1; p=0.8). One- and 5-yr CDRCC-specific survival rates were 86% and 48%, respectively, versus 86% and 57% for matched CRCC controls. ConclusionsCDRCC patients present with more advanced stage and with more aggressive disease compared with CRCC patients. After nephrectomy, when CDRCC cases were matched with CRCC, the same cause-specific survival was seen.