Partial Nephrectomy Feasible for T3a Renal Cell Carcinoma

Study shows no meaningful differences between partial and radical nephrectomy in 5-year rates of local recurrence or cancer-related death.
Study shows no meaningful differences between partial and radical nephrectomy in 5-year rates of local recurrence or cancer-related death.

SAN DIEGO—Patients with pathologic T3a renal cell carcinoma (RCC) have similar oncologic outcomes whether they undergo partial nephrectomy (PN) or radical nephrectomy (RN), researchers revealed at the 2016 American Urological Association meeting.

Asaf Shvero, MD, and colleagues of Chaim Sheba Medical Center at Tel-Hashomer, Israel, looked at oncologic outcomes among 120 RCC patients with pathologic stage T3a disease who underwent nephrectomy at their hospital during 1987–2014. Of these, 19 (16%) had PN and 101 (84%) RN. Relevant factors, such as demographics (gender, age, year of surgery) and pathological data (tumor size, histological type, stage, grade), were also examined. The average age of patients was 63.8 years, and 68% were men.

 

The investigators found no meaningful differences between PN and RN in 5-year rates of local recurrence of cancer (10.5% vs 11.8%), metastatic progression (10.5% vs 24.7%), or death from renal tumor (10.5% vs 16.8%).

Notably, all PN patients were upstaged to T3a disease after surgery. In addition, partial resections were done on significantly smaller tumors than radical resections: Tumor size was 2.5–4.6 cm in PN cases and 5–8.6 cm in RN cases.

In 18 of the 19 PN patients, the pathologic stage T3a was determined by peri-renal fat invasion. Their outcomes were compared with those of 68 RN patients with peri-renal fat invasion. The investigators again found no meaningful differences in 5-year rates of local recurrence (11.1% vs 14.7%); metastatic progression (11.1% vs 25%); and death from renal tumor (11.1% vs 17.6%for PN vs RN, respectively).

“Our findings suggest that PN may be considered for these tumors,” Dr Shvero told Renal  & Urology News. “In the future, it may be reasonable to perform PN in cases of small clinical stage T3a tumors with peri-renal fat invasion only.”

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