Search

Objective: To assess our institution's experience with the management of pathologic stage T3bNxM0 renal cell carcinoma with tumor thrombus confined to the renal vein treated with nephron-sparing surgery (NSS)., Methods: Of the 492 patients who have undergone NSS at Columbia University from 1998 to 2009, 8 patients were found to have stage T3bNxM0 renal cell carcinoma (RCC) on final pathology. Records were reviewed for indication for NSS, imaging studies, perioperative management, surgical details, pathology, and both functional and disease-specific outcomes. Postoperative renal function was estimated by most recent glomerular filtration rate using Modification of Diet in Renal Disease formula. Recurrence of RCC was monitored using serial axial imaging., Results: The 8 patients were presumed to be clinical stage T1aN0M0 RCC before surgery; however, tumor thrombus was identified in the renal vein intraoperatively and on final pathology in 4, and 4 cases, respectively, corresponding to stage T3bNxM0 RCC by current American Joint Committee on Cancer-Tumor-Necrosis-Metastasis 2002 criteria. After a median follow-up of 19.8 months, the patients experienced a mean decrease in estimated glomerular filtration rate of 27.1%. One patient developed new-onset renal failure, defined as an estimated glomerular filtration rate below 30 mL/min/1.73 m(2). Clean surgical margins were obtained in 7 patients. Carcinoma was identified at the parenchymal margin in 1 patient. No patients have evidence of recurrence of RCC by serial axial imaging., Conclusions: NSS does not seem to have had a negative impact on a small series of patients with pathologic stage T3bNxM0 RCC limited to the renal vein and may be a feasible option when the clinical situation indicates a need for preservation of renal function., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Objective: To examine the functional outcomes after radical (RN) and partial nephrectomy (PN) stratified by variables before and after surgery, using estimated glomerular filtration rate (eGFR), as nephrectomy is the standard treatment for localized renal tumours, but the risk of developing chronic kidney disease (CKD) increases after surgery., Patients and Methods: We retrospectively analysed patients treated with PN or RN for renal cancer at one institution from 1988 to 2008. Chronic renal function before and after surgery was measured using the eGFR computed using the Modification of Diet in Renal Disease equation. Four outcomes were measured: (i) presence of new-onset renal insufficiency (eGFR <60 mL/min/1.73m(2)); (ii) the percentage change in eGFR; (iii) the change in CKD stage; and (iv) the presence of CKD upstaging. Regression models were used to determine the effect of surgical procedure (RN vs PN), access technique (open vs laparoscopic) and several preoperative characteristics on functional outcomes., Results: In all, 276 patients met the inclusion criteria (174 RN and 102 PN) of whom 209 had a preoperative eGFR of >60 mL/min/1.73m(2). After >or=3 months from surgery, 108/209 (52%) patients developed new-onset eGFR of <60 mL/min/1.73m(2). On multivariate analysis, preoperative CKD stage (P < 0.001) and procedure (P= 0.001) were both independent predictors of all four functional outcomes measured. Also, hypertension was an independent predictor of CKD upstaging (P= 0.02). Surgical access technique was not an independent predictor of any of the renal functional outcomes measured., Conclusion: Patients undergoing renal surgery have a high rate of new-onset CKD afterward. After controlling for preoperative risk factors, patients undergoing RN are at greater risk of a decline in renal function. However, surgical access technique was not a significant predictor for renal impairment.