Survival outcomes in patients with large

• Published in: PloS one Vol. 13; no. 5; p. e0196427
• Main Authors: Janssen, M. W. W, Linxweiler, J, Terwey, S, Rugge, S, Ohlmann, C.-H, Becker, F, Thomas, Ch, Neisius, A, Thüroff, J. W, Siemer, S, Stöckle, M, Roos, F. C
• Format: Journal Article
• Language: English
• Published: Public Library of Science 03.05.2018
• Subjects: Analysis; Care and treatment; Comparative analysis; Nephrectomy; Patient outcomes; Renal cell carcinoma; Treatment outcome
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0196427

Does the dogma of nephron sparing surgery (NSS) still stand for large renal masses? Available studies dealing with that issue are considerably biased often mixing imperative with elective indications for NSS and also including less malignant variants or even benign renal tumors. Here, we analyzed the oncological long-term outcomes of patients undergoing elective NSS or radical tumor nephrectomy (RN) for non-endophytic, large ([greater than or equal to]7cm) clear cell renal carcinoma (ccRCC). Out of in total 8664 patients in the databases, 123 patients were identified (elective NSS (n = 18) or elective RN (n = 105)) for [greater than or equal to]7cm ccRCC. The median follow-up over all was 102 months (range 3-367 months). Compared to the RN group, the NSS group had a significantly longer median OS (p = 0.014) and median CSS (p = 0.04). In large renal masses, NSS can be performed safely with acceptable complication rates. In terms of long-term OS and CSS, NSS was at least not inferior to RN. Our findings suggest that NSS should also be performed in patients presenting with renal tumors [greater than or equal to]7cm whenever technically feasible. Limitations include its retrospective nature and the limited availability of data concerning long-term development of renal function in the two groups.