Journal List > Korean J Urol > v.48(7) > 1004953

Lee, You, Min, Park, Lee, Ahn, and Kim: Comparison of the Surgical Outcome and Renal Function between Radical and Nephron-sparing Surgery for Renal Cell Carcinomas

Abstract

Purpose

We retrospectively evaluated the outcomes of a matched comparison of nephron-sparing surgery (NSS) and radical nephrectomy (RN) for renal cell carcinoma (RCC) that was less than 4cm in size and the renal function after surgery.

Materials and Methods

Between January 1995 and February 2004, 92 and 200 patients with unilateral RCC and a normal contralateral kidney underwent NSS and RN, respectively. A total 56 patients in each cohort were matched according to the size of tumor, the pathological T stage, the pathological grade and the follow-up time. The Kaplan-Meier method was used to estimate the overall survival, the disease-free survival and the cancer-specific survival. Ninety-seven and 317 patients underwent NSS and RN during the same period, and their impaired renal function after surgery was evaluated. Postoperatively, the impaired renal function was defined as a serum creatinine value greater than 1.6mg/dl. The risk factors for impaired renal function, including diabetes, hypertension, age and the operative method were compared between the two groups. Chi-square tests and Student's t-tests were used to compare the two groups for their renal function after surgery. Multivariate logistic regression analysis was used to evaluate the preoperative risk factors for impaired renal function after surgery.

Results

There was no significant difference observed between NSS and RN with respect to overall survival (p=0.63), disease-free survival (p=0.18) and cancer-specific survival (p=0.98). Postoperatively, the impaired renal function was significantly different between the two groups (p=0.045, chi-square). The only preoperative risk factor for impaired renal function after surgery was diabetes (p=0.044).

Conclusions

The surgical outcomes for renal cell carcinoma that's less than 4cm in size were comparable between NSS and RN. The only preoperative risk factor for impaired renal function after surgery was diabetes.

Figures and Tables

Fig. 1
5-year cancer-specific survival rates for patients who underwent nephron-sparing surgery (NSS) and radical nephrectomy (RN) for pT1a RCC.
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Table 1
Comparison of the patients' characteristics
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NSS: nephron-sparing surgery, RN: radical nephrectomy

Table 2
Results of NSS and RN for pT1a RCC
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NSS: nephron-sparing surgery, RN: radical nephrectomy, RCC: renal cell carcinoma

Table 3
Distribution of the preoperative risk factors for impaired renal function after surgery
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NSS: nephron-sparing surgery, RN: radical nephrectomy, Cr: creatinine

Table 4
Preoperative and postoperative serum creatinine levels according to the operative method
kju-48-671-i004

NSS: nephron-sparing surgery, RN: radical nephrectomy, Cr: serum creatinine level (mg/dl)

Table 5
Multivariate analysis of the preoperative risk factors for impaired renal function after surgery
kju-48-671-i005
Table 6
Mean value of the elevation of serum creatinine after operation according to the operation method, diabetes and hypertension
kju-48-671-i006

NSS: nephron-sparing surgery, RN: radical nephrectomy

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