Skip to main content
SpringerLink
Log in

Nephron sparing surgery for renal cell carcinoma up to 7 cm in the context of guideline development: a contribution of healthcare research

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Introduction

If technically feasible, organ-preservation is indicated for T1 renal cell carcinoma (RCC), since partial nephrectomy (PN) is equivalent to radical nephrectomy with regard to tumor-specific survival and probably achieves better overall survival. Treatment results of a training clinic were assessed with regard to guideline adherence and treatment quality.

Methods

Based on 220 open interventions in the time periods 2006–2009 (TP1) and 2010–2013 (TP2), a retrospective single center examination was performed to determine the influence of patient-age, sex, BMI, ASA-score, preoperative eGFR, PADUA-score and surgeon’s experience on PN-rate and trifecta-outcome (R0 resection, warm ischemia time ≤25 min, no intraoperative complications and no blood-transfusion and postoperative complications grade ≤1 Clavien and Dindo).

Results

PN-rate increased from 36.1 % in TP1 to 72.4 % in TP2. Despite significantly higher PADUA-scores in TP2 than in TP1 (p = 0.0038), the trifecta-rate did not differ significantly (TP1 65.7 %; TP2 70.8 %; p = 0.666). Only the PADUA-score exerted an independent influence on the endpoints “organ-preservation” and “trifecta-outcome”.

Conclusions

This study again demonstrated that the PADUA-score is a robust predictor of technical feasibility and treatment outcome for open PN. Consistent implementation of guidelines for nephron sparing surgery in RCC ≤7 cm is possible even in the setting of a training clinic and need not be associated with compromised treatment quality despite the increasing level of difficulty. Depending on the author, there are various definitions of trifecta-outcome. A uniform trifecta-concept would be desirable.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Huang WC, Elkin EB, Levey AS, Jang TL, Russo P (2009) Partial nephrectomy versus radical nephrectomy in patients with small renal tumors–is there a difference in mortality and cardiovascular outcomes? J Urol 181(1):55–61. doi:10.1016/j.juro.2008.09.017 (discussion 61–52)

    Article  PubMed  Google Scholar 

  2. Krebs RK, Andreoni C, Ortiz V (2014) Impact of radical and partial nephrectomy on renal function in patients with renal cancer. Urol Int 92(4):449–454. doi:10.1159/000355609

    Article  CAS  PubMed  Google Scholar 

  3. Ljungberg B, Bensalah K, Canfield S, Dabestani S, Hofmann F, Hora M, Kuczyk MA, Lam T, Marconi L, Merseburger AS, Mulders P, Powles T, Staehler M, Volpe A, Bex A (2015) EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 67(5):913–924. doi:10.1016/j.eururo.2015.01.005

    Article  PubMed  Google Scholar 

  4. Thompson RH, Boorjian SA, Lohse CM, Leibovich BC, Kwon ED, Cheville JC, Blute ML (2008) Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy. J Urol 179(2):468–471. doi:10.1016/j.juro.2007.09.077 (discussion 472–463)

    Article  PubMed  Google Scholar 

  5. 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 (2011) 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 59(4):543–552. doi:10.1016/j.eururo.2010.12.013

    Article  PubMed  Google Scholar 

  6. Weight CJ, Lieser G, Larson BT, Gao T, Lane BR, Campbell SC, Gill IS, Novick AC, Fergany AF (2010) Partial nephrectomy is associated with improved overall survival compared to radical nephrectomy in patients with unanticipated benign renal tumours. Eur Urol 58(2):293–298. doi:10.1016/j.eururo.2010.04.033

    Article  PubMed  Google Scholar 

  7. Hofbauer SL, de Martino M, Seemann C, Zamani N, Lucca I, Haitel A, Shariat SF, Klatte T (2014) Associations between presenting symptoms, clinicopathological parameters, and prognosis in a contemporary series of patients with renal cell carcinoma. Korean J Urol 55(8):505–510. doi:10.4111/kju.2014.55.8.505

    Article  PubMed  PubMed Central  Google Scholar 

  8. Bjurlin MA, Walter D, Taksler GB, Huang WC, Wysock JS, Sivarajan G, Loeb S, Taneja SS, Makarov DV (2013) National trends in the utilization of partial nephrectomy before and after the establishment of AUA guidelines for the management of renal masses. Urology 82(6):1283–1289. doi:10.1016/j.urology.2013.07.068

    Article  PubMed  Google Scholar 

  9. Thompson RH, Kaag M, Vickers A, Kundu S, Bernstein M, Lowrance W, Galvin D, Dalbagni G, Touijer K, Russo P (2009) Contemporary use of partial nephrectomy at a tertiary care center in the United States. J Urol 181(3):993–997

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ljungberg B, Cowan NC, Hanbury DC, Hora M, Kuczyk MA, Merseburger AS, Patard JJ, Mulders PF, Sinescu IC, European Association of Urology Guideline G (2010) EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 58(3):398–406. doi:10.1016/j.eururo.2010.06.032

    Article  PubMed  Google Scholar 

  11. Ljungberg B, Hanbury DC, Kuczyk MA, Merseburger AS, Mulders PF, Patard JJ, Sinescu IC, European Association of Urology Guideline Group for renal cell c (2007) Renal cell carcinoma guideline. Eur Urol 51(6):1502–1510. doi:10.1016/j.eururo.2007.03.035

    Article  PubMed  Google Scholar 

  12. Ficarra V, Novara G, Secco S, Macchi V, Porzionato A, De Caro R, Artibani W (2009) Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol 56(5):786–793. doi:10.1016/j.eururo.2009.07.040

    Article  PubMed  Google Scholar 

  13. Mottrie A, Schatteman P, De Wil P, De Troyer B, Novara G, Ficarra V (2013) Validation of the preoperative aspects and dimensions used for an anatomical (PADUA) score in a robot-assisted partial nephrectomy series. World J Urol 31(4):799–804. doi:10.1007/s00345-010-0639-y

    Article  PubMed  Google Scholar 

  14. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hung AJ, Cai J, Simmons MN, Gill IS (2013) “Trifecta” in partial nephrectomy. J Urol 189(1):36–42. doi:10.1016/j.juro.2012.09.042

    Article  PubMed  Google Scholar 

  16. Khalifeh A, Autorino R, Hillyer SP, Laydner H, Eyraud R, Panumatrassamee K, Long JA, Kaouk JH (2013) Comparative outcomes and assessment of trifecta in 500 robotic and laparoscopic partial nephrectomy cases: a single surgeon experience. J Urol 189(4):1236–1242. doi:10.1016/j.juro.2012.10.021

    Article  PubMed  Google Scholar 

  17. Komninos C, Shin TY, Tuliao P, Yoon YE, Koo KC, Chang CH, Kim SW, Ha JY, Han WK, Rha KH (2014) R-LESS partial nephrectomy trifecta outcome is inferior to multiport robotic partial nephrectomy: comparative analysis. Eur Urol 66(3):512–517. doi:10.1016/j.eururo.2013.10.058

    Article  PubMed  Google Scholar 

  18. Minervini A, Siena G, Antonelli A, Bianchi G, Bocciardi AM, Cosciani Cunico S, Ficarra V, Fiori C, Fusco F, Mari A, Martorana G, Medica M, Mirone V, Morgia G, Porpiglia F, Rocco F, Rovereto B, Schiavina R, Simeone C, Terrone C, Volpe A, Carini M, Serni S, Members of the RP-LF (2014) Open versus laparoscopic partial nephrectomy for clinical T1a renal masses: a matched-pair comparison of 280 patients with TRIFECTA outcomes (RECORd Project). World J Urol 32(1):257–263. doi:10.1007/s00345-013-1155-7

    Article  PubMed  Google Scholar 

  19. Ploussard G, Haddad R, Kovac E, Richard P, Anidjar M, Bladou F (2013) Robot-assisted laparoscopic partial nephrectomy: early single Canadian institution experience. Can Urol Assoc J 7(9–10):348–354. doi:10.5489/cuaj.753

    Article  PubMed  PubMed Central  Google Scholar 

  20. Takagi T, Mir MC, Campbell RA, Sharma N, Remer EM, Li J, Demirjian S, Kaouk JH, Campbell SC (2014) Assessment of outcomes in partial nephrectomy incorporating detailed functional analysis. Urology 84(5):1128–1133. doi:10.1016/j.urology.2014.07.008

    Article  PubMed  Google Scholar 

  21. Zargar H, Allaf ME, Bhayani S, Stifelman M, Rogers C, Ball MW, Larson J, Marshall S, Kumar R, Kaouk JH (2014) Trifecta and optimal perioperative outcomes of robotic and laparoscopic partial nephrectomy in surgical treatment of small renal masses: a multi-institutional study. BJU Int. doi:10.1111/bju.12933

    Google Scholar 

  22. Sankar A, Johnson SR, Beattie WS, Tait G, Wijeysundera DN (2014) Reliability of the American Society of Anesthesiologists physical status scale in clinical practice. Br J Anaesth 113(3):424–432. doi:10.1093/bja/aeu100

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Zini L, Patard J-J, Capitanio U, Mejean A, Villers A, De La Taille A, Ficarra V, Crepel M, Bertini R, Salomon L (2009) The use of partial nephrectomy in European tertiary care centers. Eur J Surg Oncol (EJSO) 35(6):636–642

    Article  CAS  Google Scholar 

  24. Kutikov A, Uzzo RG (2009) The RENAL nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182(3):844–853. doi:10.1016/j.juro.2009.05.035

    Article  PubMed  Google Scholar 

  25. Simmons MN, Ching CB, Samplaski MK, Park CH, Gill IS (2010) Kidney tumor location measurement using the C index method. J Urol 183(5):1708–1713. doi:10.1016/j.juro.2010.01.005

    Article  PubMed  Google Scholar 

  26. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 130(6):461–470

    Article  CAS  PubMed  Google Scholar 

  27. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J, Ckd EPI (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150(9):604–612

    Article  PubMed  PubMed Central  Google Scholar 

  28. Bagheri F, Pusztai C, Farkas L, Kallidonis P, Buzogany I, Szabo Z, Lantos J, Imre M, Farkas N, Szanto A (2016) Impact of parenchymal loss on renal function after laparoscopic partial nephrectomy under warm ischemia. World J Urol. doi:10.1007/s00345-016-1798-2

    PubMed  Google Scholar 

  29. Mibu H, Tanaka N, Hosokawa Y, Kumamoto H, Margami N, Hirao Y, Fujimoto K (2015) Estimated functional renal parenchymal volume predicts the split renal function following renal surgery. World J Urol 33(10):1571–1577. doi:10.1007/s00345-014-1470-7

    Article  PubMed  Google Scholar 

  30. Bessede T, Bigot P, Bernhard JC, Pignot G, Bouliere F, Verhoest G, Crepel M, Salomon L, Mottet N, Bellec L, Soulie M, Ferriere JM, Pfister C, Albouy B, Pouliot F, Dujardin T, Bensalah K, Patard JJ (2015) Are warm ischemia and ischemia time still predictive factors of poor renal function after partial nephrectomy in the setting of elective indication? World J Urol 33(1):11–15. doi:10.1007/s00345-014-1292-7

    Article  CAS  PubMed  Google Scholar 

  31. Ghoneim TP, Sjoberg DD, Lowrance W, Shariat SF, Savage C, Bernstein M, Russo P (2015) Partial nephrectomy for renal tumors in solitary kidneys: postoperative renal function dynamics. World J Urol 33(12):2023–2029. doi:10.1007/s00345-015-1581-9

    Article  PubMed  PubMed Central  Google Scholar 

  32. Thompson RH, Lane BR, Lohse CM, Leibovich BC, Fergany A, Frank I, Gill IS, Blute ML, Campbell SC (2012) Renal function after partial nephrectomy: effect of warm ischemia relative to quantity and quality of preserved kidney. Urology 79(2):356–360. doi:10.1016/j.urology.2011.10.031

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology and Pediatric Urology, Ruppin Clinics, Brandenburg Medical Center and School of Medicine, Fehrbelliner Straße 38, 16816, Neuruppin, Germany

    Steffen Lebentrau & Sven Rauter

  2. Department of Urology and Pediatric Urology, Magdeburg University Medical Center, Leipziger Str. 44, 39120, Magdeburg, Germany

    Daniel Baumunk, Frank Christoph, Frank König & Martin Schostak

  3. Urology City West, Joachim-Friedrich-Str. 16, 10711, Berlin, Germany

    Frank Christoph

  4. ATURO Joint Urology Practice, Mecklenburgische Str. 27, 14197, Berlin, Germany

    Frank König

  5. Department of Urology, St. Elisabeth Hospital, St.-Elisabeth-Str. 23, 94315, Straubing, Germany

    Matthias May

Authors
  1. Steffen Lebentrau
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sven Rauter
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniel Baumunk
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Frank Christoph
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Frank König
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Matthias May
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Martin Schostak
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steffen Lebentrau.

Ethics declarations

Ethical standards

We affirm that all authors have complied with the principles of the World Journal of Urology regarding ethical responsibilities of authors and compliance with ethical standards.

Conflict of interest

None of the contributing authors have any conflict of interest, including specific financial interests or relationships and affiliations relevant to the subject matter or materials discussed in the manuscript.

Additional information

Matthias May and Martin Schostak share last author status.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lebentrau, S., Rauter, S., Baumunk, D. et al. Nephron sparing surgery for renal cell carcinoma up to 7 cm in the context of guideline development: a contribution of healthcare research. World J Urol 35, 753–759 (2017). https://doi.org/10.1007/s00345-016-1905-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-016-1905-4

Keywords

Search

Navigation