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Partial nephrectomy versus ablative therapy for the treatment of renal tumors in an imperative setting
- Source :
- World Journal of Urology, World Journal of Urology, 2017, 35 (4), pp.649-656. ⟨10.1007/s00345-016-1913-4⟩, World Journal of Urology, Springer Verlag, 2017, 35 (4), pp.649-656. ⟨10.1007/s00345-016-1913-4⟩
- Publication Year :
- 2017
- Publisher :
- HAL CCSD, 2017.
-
Abstract
- International audience; Purpose - To compare partial nephrectomy (PN) and percutaneous ablative therapy (AT) for renal tumor in imperative indication of nephron-sparing technique (NST). Materials and methods - Between 2000 and 2015, 284 consecutive patients with a kidney tumor in an imperative indication of NST were retrospectively included in a multicenter study. PN [open (n = 146), laparoscopic (n = 9), or robotic approach (n = 17)] and AT [radiofrequency ablation (n = 104) or cryoablation (n = 8)] were performed for solitary kidney (n = 146), bilateral tumor (n = 78), or chronic kidney disease (CKD) (n = 60). Results - Patients in the PN group had larger tumors and a higher RENAL score. There were no differences between the two groups with respect to age, reasons for imperative indication, and preoperative eGFR. Patients in the AT group had a higher ASA and CCI. PN had worse outcomes than AT in terms of transfusion rate, length of stay, and complication rate. Local radiological recurrence-free survival was better for PN, but metastatic recurrence was similar. Percentage of eGFR decrease was similar in the two groups. Temporary or permanent dialysis was not significantly different. On multivariate analysis, PN and AT had a similar eGFR change when adjusted for tumor complexity, reason of imperative indication and CCI. Conclusion - In imperative indication of nephron-sparing treatment for a kidney tumor, either PN or AT can be proposed. PN offers the ability to manage larger and more complex tumors while providing a better local control and a similar renal function loss.
- Subjects :
- Nephrology
Ablation Techniques
Male
Percutaneous
Radiofrequency ablation
medicine.medical_treatment
[SDV]Life Sciences [q-bio]
030232 urology & nephrology
Comorbidity
Kidney
Cryosurgery
Nephrectomy
law.invention
Neoplasms, Multiple Primary
0302 clinical medicine
Postoperative Complications
Robotic Surgical Procedures
law
Partial nephrectomy
Cryoablation
Middle Aged
Kidney Neoplasms
3. Good health
Tumor Burden
Treatment Outcome
Renal cancer
030220 oncology & carcinogenesis
Catheter Ablation
Female
Kidney Diseases
Glomerular Filtration Rate
medicine.medical_specialty
Urology
Renal function
Imperative indication
Disease-Free Survival
Congenital Abnormalities
03 medical and health sciences
Internal medicine
medicine
Humans
Blood Transfusion
Renal Insufficiency, Chronic
Carcinoma, Renal Cell
Dialysis
Aged
Retrospective Studies
business.industry
Nephrons
Length of Stay
medicine.disease
Surgery
Radiofrequency
Multivariate Analysis
Laparoscopy
business
Organ Sparing Treatments
Kidney disease
Subjects
Details
- Language :
- English
- ISSN :
- 07244983 and 14338726
- Database :
- OpenAIRE
- Journal :
- World Journal of Urology, World Journal of Urology, 2017, 35 (4), pp.649-656. ⟨10.1007/s00345-016-1913-4⟩, World Journal of Urology, Springer Verlag, 2017, 35 (4), pp.649-656. ⟨10.1007/s00345-016-1913-4⟩
- Accession number :
- edsair.doi.dedup.....a9d177914e88e027c98245316567d716