Partial and radical nephrectomy for unilateral synchronous multifocal renal cortical tumors Journal Article

Authors: Mano, R.; Kent, M.; Larish, Y.; Winer, A. G.; Chevinsky, M. S.; Hakimi, A. A.; Sternberg, I. A.; Sjoberg, D. D.; Russo, P.
Article Title: Partial and radical nephrectomy for unilateral synchronous multifocal renal cortical tumors
Abstract: Objective To evaluate clinicopathologic characteristics and treatment outcomes of patients undergoing partial nephrectomy (PN) or radical nephrectomy (RN) for unilateral synchronous multifocal renal tumors. Methods We retrospectively reviewed medical records for 128 patients with nonmetastatic, unilateral, synchronous, multifocal renal tumors who underwent surgical resection at our institution from 1995 to 2012. Five patients with hereditary renal cell carcinoma were excluded. Differences between patient and tumor characteristics from the 2 nephrectomy groups were evaluated. Outcomes in terms of recurrence-free survival, overall survival, and chronic kidney disease upstaging were estimated using Kaplan-Meier methods. The log-rank test was used for group comparisons. Results The study cohort included 78 PN patients (63%) and 45 RN patients (37%); 17 of 95 planned PN (18%) were converted to RN. Tumor diameter and RENAL nephrometry scores were greater in RN patients (P <.0001 and P =.0002, respectively). Pathologic stage T3 was seen in 40% of RN patients and 10% of PN patients (P =.0002). Histologic concordance was apparent in 60 of 123 patients (49%). Median follow-up for patients alive without a recurrence was 4 years. Five-year recurrence-free survival was 98% for PN and 85% for RN. Five-year overall survival was 96% for PN and 86% for RN (P =.5). Five-year freedom from chronic kidney disease upstaging was 74% for PN and 55% for RN (P =.11). Conclusion Partial nephrectomy for the treatment of unilateral, synchronous, multifocal, renal tumors with favorable characteristics was associated with a low recurrence rate. These findings suggest PN is an appropriate management strategy for this group of carefully selected patients. © 2015 Elsevier Inc.
Keywords: adult; treatment outcome; aged; middle aged; cancer surgery; major clinical study; overall survival; histopathology; treatment planning; recurrence risk; follow up; tumor volume; cohort analysis; medical record review; retrospective study; nephrectomy; postoperative complication; disease severity; partial nephrectomy; radical nephrectomy; kidney tumor; kidney function; chronic kidney disease; scoring system; kaplan meier method; recurrence free survival; renal nephrometry score; human; male; female; priority journal; article
Journal Title: Urology
Volume: 85
Issue: 6
ISSN: 0090-4295
Publisher: Elsevier Science, Inc.  
Date Published: 2015-06-01
Start Page: 1404
End Page: 1410
Language: English
DOI: 10.1016/j.urology.2015.02.032
PROVIDER: scopus
PUBMED: 25872696
PMCID: PMC4972183
Notes: Export Date: 3 August 2015 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Paul Russo
    449 Russo
  2. Daniel D. Sjoberg
    139 Sjoberg
  3. Andrew Gordon Winer
    18 Winer
  4. Abraham Ari Hakimi
    129 Hakimi
  5. Roy Mano
    21 Mano
  6. Matthew T Kent
    26 Kent
  7. Yaniv M Larish
    4 Larish