Long-term outcome of multiple ipsilateral renal tumours found at the time of planned nephron-sparing surgery

Amy Krambeck, Markian Iwaszko, Bradley Leibovich, John Cheville, Igor Frank, Michael Blute

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

OBJECTIVE: To evaluate patients with multiple ipsilateral renal tumours and to determine outcomes of nephron-sparing surgery (NSS) and radical nephrectomy (RN), as the treatment of unrecognized sporadic multifocal tumours at NSS presents a surgical dilemma. PATIENTS AND METHODS: In all, 104 patients had surgery between 1970 and 2003 for sporadic multiple ipsilateral renal tumours, at least one of which was renal cell carcinoma (RCC); 114 were treated with RN and 26 with NSS. Cancer-specific survival (CSS) was estimated using the Kaplan-Meier method. RESULTS: More patients treated with NSS had a solitary kidney than those undergoing RN (six, 23%, vs none, P < 0.001). Seventeen of the 114 having RN died from RCC at a median (range) of 3.4 (0.25-10.3) years after RN. The estimated 5-year CSS was 90.5%. There was metachronous recurrence in nine patients at a median of 5.6 (1-14) years after. Two of the 26 patients having NSS died from RCC at 1 and 6 years after NSS; the 5-year CSS was 95.8%. There was local or metachronous recurrence in three patients at 7 months to 6 years after surgery; all three were alive at the last follow-up. In 26 (23%) of the 114 patients treated with RN, only one tumour was RCC. CONCLUSION: Patients undergoing either RN or NSS for multiple ipsilateral renal tumours have a favourable CSS. A planned NSS is safe if small satellite lesions are resectable.

Original languageEnglish (US)
Pages (from-to)1375-1379
Number of pages5
JournalBJU International
Volume101
Issue number11
DOIs
StatePublished - Jun 2008
Externally publishedYes

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Nephrons
Nephrectomy
Kidney
Neoplasms
Renal Cell Carcinoma
Survival
Recurrence

Keywords

  • Carcinoma
  • Multifocal
  • Nephron-sparing surgery
  • Renal cell

ASJC Scopus subject areas

  • Urology

Cite this

Long-term outcome of multiple ipsilateral renal tumours found at the time of planned nephron-sparing surgery. / Krambeck, Amy; Iwaszko, Markian; Leibovich, Bradley; Cheville, John; Frank, Igor; Blute, Michael.

In: BJU International, Vol. 101, No. 11, 06.2008, p. 1375-1379.

Research output: Contribution to journalArticle

Krambeck, Amy ; Iwaszko, Markian ; Leibovich, Bradley ; Cheville, John ; Frank, Igor ; Blute, Michael. / Long-term outcome of multiple ipsilateral renal tumours found at the time of planned nephron-sparing surgery. In: BJU International. 2008 ; Vol. 101, No. 11. pp. 1375-1379.
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AU - Iwaszko, Markian

AU - Leibovich, Bradley

AU - Cheville, John

AU - Frank, Igor

AU - Blute, Michael

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N2 - OBJECTIVE: To evaluate patients with multiple ipsilateral renal tumours and to determine outcomes of nephron-sparing surgery (NSS) and radical nephrectomy (RN), as the treatment of unrecognized sporadic multifocal tumours at NSS presents a surgical dilemma. PATIENTS AND METHODS: In all, 104 patients had surgery between 1970 and 2003 for sporadic multiple ipsilateral renal tumours, at least one of which was renal cell carcinoma (RCC); 114 were treated with RN and 26 with NSS. Cancer-specific survival (CSS) was estimated using the Kaplan-Meier method. RESULTS: More patients treated with NSS had a solitary kidney than those undergoing RN (six, 23%, vs none, P < 0.001). Seventeen of the 114 having RN died from RCC at a median (range) of 3.4 (0.25-10.3) years after RN. The estimated 5-year CSS was 90.5%. There was metachronous recurrence in nine patients at a median of 5.6 (1-14) years after. Two of the 26 patients having NSS died from RCC at 1 and 6 years after NSS; the 5-year CSS was 95.8%. There was local or metachronous recurrence in three patients at 7 months to 6 years after surgery; all three were alive at the last follow-up. In 26 (23%) of the 114 patients treated with RN, only one tumour was RCC. CONCLUSION: Patients undergoing either RN or NSS for multiple ipsilateral renal tumours have a favourable CSS. A planned NSS is safe if small satellite lesions are resectable.

AB - OBJECTIVE: To evaluate patients with multiple ipsilateral renal tumours and to determine outcomes of nephron-sparing surgery (NSS) and radical nephrectomy (RN), as the treatment of unrecognized sporadic multifocal tumours at NSS presents a surgical dilemma. PATIENTS AND METHODS: In all, 104 patients had surgery between 1970 and 2003 for sporadic multiple ipsilateral renal tumours, at least one of which was renal cell carcinoma (RCC); 114 were treated with RN and 26 with NSS. Cancer-specific survival (CSS) was estimated using the Kaplan-Meier method. RESULTS: More patients treated with NSS had a solitary kidney than those undergoing RN (six, 23%, vs none, P < 0.001). Seventeen of the 114 having RN died from RCC at a median (range) of 3.4 (0.25-10.3) years after RN. The estimated 5-year CSS was 90.5%. There was metachronous recurrence in nine patients at a median of 5.6 (1-14) years after. Two of the 26 patients having NSS died from RCC at 1 and 6 years after NSS; the 5-year CSS was 95.8%. There was local or metachronous recurrence in three patients at 7 months to 6 years after surgery; all three were alive at the last follow-up. In 26 (23%) of the 114 patients treated with RN, only one tumour was RCC. CONCLUSION: Patients undergoing either RN or NSS for multiple ipsilateral renal tumours have a favourable CSS. A planned NSS is safe if small satellite lesions are resectable.

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