NSS for Larger Renal Tumors

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Nephron-sparing surgery may be appropriate for this 5 cm left renal mass.
Nephron-sparing surgery may be appropriate for this 5 cm left renal mass.
This approach preserves renal function better than radical nephrectomy in patients with tumors up to 7 cm in size.

CHICAGO—Nephron-sparing surgery (NSS) is an accepted treatment for patients with renal tumors 4 cm or smaller in diameter, but new findings suggest that it may be an appropriate option for larger tumors.

Two studies presented here at the American Urological Association annual meeting suggest that the use of NSS instead of radical nephrectomy (RN) for tumors larger than 4 cm provides renal function benefits and does not compromise cancer-specific or overall survival.

Jean Jacque Patard, MD, PhD, professor of urology at the University of Rennes in Rennes, France, and his colleagues studied 1,339 patients (881 men, 458 women) with a median age at diagnosis of 60 years. Of these, 690 patients (51.5%) underwent NSS and 649 (48.5%) had RN. The median follow-up duration for the two groups was similar: 42.9 and 42.4 months, respectively. Among patients with malignant tumors, 11.2% died from cancer.

With respect to tumor size, 670 tumors (50%) were 4 cm or less, 36 (27.3%) were more than 4 cm but not more than 7 cm, and 304 (22.7%) were larger than 7 cm. The primary outcome measure was a decline in estimated glomerular filtration rate (eGFR) to 30-60 or below 30 mL/min/1.73 m2, according to the Modification of Diet in Renal Disease (MDRD) study formula.

Among subjects who had tumors 4 cm or less in size, 543 underwent NSS and 127 underwent RN. Among subjects with tumors larger than 4 cm, 147 underwent NSS and 522 underwent RN. Dr. In the NSS group, the investigators observed a significant advantage in terms of renal function preservation for tumors less than 4 cm and for tumors between 4 cm and 7 cm. In multivariate analysis, the type of surgery was an independent predictor of renal function outcome, but tumor size was not.
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