Daniele Amparore1,2, Angela Pecoraro3,4, Federico Piramide3, Enrico Checcucci3,5, Sabrina DE Cillis3, Gabriele Volpi3, Alberto Piana3, Paolo Verri3, Stefano Granato3, Michele Sica3, Matteo Manfredi3, Cristian Fiori3, Francesco Porpiglia3. 1. Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy - danieleamparore@hotmail.it. 2. Renal Cancer Working Group of the Young Academic Urologists (YAU), Working Party of the European Association of Urology (EAU), Arnhem, The Netherlands - danieleamparore@hotmail.it. 3. Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy. 4. Renal Cancer Working Group of the Young Academic Urologists (YAU), Working Party of the European Association of Urology (EAU), Arnhem, The Netherlands. 5. Uro-technology and SoMe Working Group of the Young Academic Urologists (YAU), Working Party of the European Association of Urology (EAU), Arnhem, The Netherlands.
Abstract
BACKGROUND: Even if partial nephrectomy (PN) is nowadays considered the standard for managing cT1 renal masses, its role in the management of cT2 kidney tumors is controversial. We aimed to compare oncologic and functional outcomes of minimally invasive radical nephrectomy (RN) and PN in cT2 renal masses. METHODS: Patients with cT2 renal masses underwent minimally-invasive PN or RN performed by a highly experienced single surgeon from 2009 to 2019 were considered. Demographic, perioperative and functional variables were compared. Cumulative incidence plot and competing risks regression (CRR) models were used to test differences in 5-year-CSM (Cancer Specific Mortality) and 5-year- OCM (Other Causes Mortality) rates. Kaplan-Meier and Cox regression model was used to test differences in 5-year progression free survival (PFS) rates. RESULTS: Overall, 52 PN vs 64 RN patients were identified. Relative to RN, PN patients recorded higher rates of complications (25% vs 7.8%, p=0.02) but lower upstaging rate (≥pT3a 64.1% vs 19.2%, p<0.0001). Functional outcomes were in favor of PN (all p<0.001). No differences were recorded between 5-year CSM and OCM according to nephrectomy type. At CRR models, older age and upstaging were independent predictors of 5-year OCM and CSM, respectively (all p<0.01). Finally, only upstaging, high grade tumors and presence of positive surgical margins were identified as independent predictors of 5 years PFS (all p<0.01). CONCLUSIONS: In experienced hands the treatment of cT2 renal neoplasms with minimally-invasive PN is feasible, providing perioperative and oncological safety profiles comparable to RN, with advantages in terms of functional outcomes.
BACKGROUND: Even if partial nephrectomy (PN) is nowadays considered the standard for managing cT1 renal masses, its role in the management of cT2kidney tumors is controversial. We aimed to compare oncologic and functional outcomes of minimally invasive radical nephrectomy (RN) and PN in cT2 renal masses. METHODS:Patients with cT2 renal masses underwent minimally-invasive PN or RN performed by a highly experienced single surgeon from 2009 to 2019 were considered. Demographic, perioperative and functional variables were compared. Cumulative incidence plot and competing risks regression (CRR) models were used to test differences in 5-year-CSM (Cancer Specific Mortality) and 5-year- OCM (Other Causes Mortality) rates. Kaplan-Meier and Cox regression model was used to test differences in 5-year progression free survival (PFS) rates. RESULTS: Overall, 52 PN vs 64 RN patients were identified. Relative to RN, PN patients recorded higher rates of complications (25% vs 7.8%, p=0.02) but lower upstaging rate (≥pT3a 64.1% vs 19.2%, p<0.0001). Functional outcomes were in favor of PN (all p<0.001). No differences were recorded between 5-year CSM and OCM according to nephrectomy type. At CRR models, older age and upstaging were independent predictors of 5-year OCM and CSM, respectively (all p<0.01). Finally, only upstaging, high grade tumors and presence of positive surgical margins were identified as independent predictors of 5 years PFS (all p<0.01). CONCLUSIONS: In experienced hands the treatment of cT2renal neoplasms with minimally-invasive PN is feasible, providing perioperative and oncological safety profiles comparable to RN, with advantages in terms of functional outcomes.
Authors: Faris Abushamma; Abdulkarim Barqawi; Samah W Al-Jabi; Maha Akkawi; Mosab Maree; Sa'ed H Zyoud Journal: Cancer Manag Res Date: 2021-09-27 Impact factor: 3.989