[Partial nephrectomy vs. radical nephrectomy for tumor>7cm]

Abstract

Introduction: The usefulness of partial nephrectomy (PN) has been demonstrated for the treatment of renal tumor<7cm and it is now the standard treatment for such lesions. However, few studies are available regarding tumors≥T2. The objective of this study was to assess PN results for the treatment of renal tumors>7cm.

Materials and methods: A retrospective two-center study was performed, including 170 patients treated. Thirty-two patients underwent PN and 138 radical nephrectomy (RN) for renal cT2 tumors between 2004 and 2014. The biological and clinical characteristics including perioperative morbidity as well as the survival rate were compared between these 2 groups.

Results: The median age was 59.5 years and the median follow-up was 47 months. More cT2b tumors were treated through RN (34.1% vs. 12.5%, P=0.01). The postoperative decrease in creatinine clearance was higher for the RN group (-24.3mL/min vs. -16.8; P=0.04). This difference was no longer significant at last follow-up. Perioperative complications were more frequent in the PN group (50.0% vs. 18.1%; P=0.008), and more severe (Clavien≥3 18.7% vs. 5.1%, P=0.01). No difference was found regarding the overall survival. Surgical margins were more frequent in the PN group (9.1% vs. 0.85%; P=0.01).

Conclusion: Our results suggested the feasibility of PN for renal tumors>7cm, involving however a higher perioperative complication risk. Cautious patient selection appeared to be required for the indication of PN for large tumors.

Level of evidence: 4.

Keywords: Morbidité périopératoires; Néphrectomie partielle; Néphrectomie élargie; Partial nephrectomy; Radical nephrectomy; Surgical mobidity; Survie; Survival; Taille tumorale; Tumor size.