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Organ-sparing procedures in GU cancer: part 1—organ-sparing procedures in renal and adrenal tumors: a systematic review

  • Raouf Seyam
  • Mahmoud I. Khalil
  • Mohamed H. Kamel
  • Waleed M. Altaweel
  • Rodney Davis
  • Nabil K. BissadaEmail author
Urology - Review
  • 31 Downloads

Abstract

Purpose

Organ-sparing surgery (OSS) for the kidney and adrenals has emerged as the need for preservation of function is paramount in patients with poor functional reserve. As reports increasingly showed that oncological outcomes were equivalent to radical excision, elective OSS became a viable alternative in patients with otherwise normal reserve. In this review, we summarize the current knowledge of OSS for adrenal and renal tumors.

Materials and methods

PubMed, Web of Science and Cochrane Library Central Search were searched for recently published articles up to December 2017. The following keywords were used; “partial adrenalectomy”, “adrenal sparing”, “partial nephrectomy”, “nephron sparing”, “kidney/renal cancer”.

Results

Partial adrenalectomy became an attractive alternative to total adrenalectomy avoiding adrenal insufficiency. Both minimally invasive surgery and ablative techniques were increasingly reported for adrenal OSS with adequate residual adrenal function and excellent oncological outcome. Radical nephrectomy remained for many years as the gold standard of treatment for organ-confined renal cell carcinoma. As the need to reduce the impact on renal function, more conservative approaches were utilized. Soon, the non-inferiority of nephron-sparing surgery to that of radical excision became evident and elective partial nephrectomy was gaining ground as the standard of care for small renal masses in patients with normal contralateral kidneys.

Conclusions

Herein, we present a comprehensive review of the current status of OSS in renal and adrenal tumors.

Keywords

Organ sparing Nephron sparing Partial nephrectomy Partial adrenalectomy 

Abbreviations

AS

Active surveillance

CKD

Chronic kidney disease

CSS

Cancer-specific survival

DFS

Disease-free survival

LPN

Laparoscopic partial nephrectomy

NSS

Nephron-sparing surgery

PN

Partial nephrectomy

RCC

Renal cell carcinoma

RFA

Radiofrequency ablation

RFR

Recurrence-free rate

RN

Radical nephrectomy

RPN

Robotic partial nephrectomy

PTA

Percutaneous thermal ablation

SABR

Stereotactic ablative radiotherapy

SRMs

Small renal masses

SEER

Surveillance, Epidemiology, and End Results

TA

Thermal ablation

WIT

Warm ischemia time

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Raouf Seyam
    • 1
  • Mahmoud I. Khalil
    • 2
  • Mohamed H. Kamel
    • 2
  • Waleed M. Altaweel
    • 1
  • Rodney Davis
    • 2
  • Nabil K. Bissada
    • 3
    Email author
  1. 1.Department of UrologyKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
  2. 2.Department of UrologyUniversity of Arkansas for Medical SciencesLittle RockUSA
  3. 3.Department of UrologyBaylor College of Medicine and Michael E. De Bakey VA Medical CenterHoustonUSA

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