Long-term results of surgical treatment for stage cT1 kidney cancer

Abstract

Studied herein are the long-term results after surgical treatment of stage cT1 kidney cancer. The study includes 278 surgeries for kidney tumors. Partial nephrectomy was performed in 199 (71.6%) cases and radical nephrectomy in 79 (28.4%). Surgeries were performed using the open, laparoscopic, and robotic approaches. Surgical treatment and long-term oncological results were studied. Open approach for partial nephrectomy was used in 2.01% of cases, laparoscopic in 27.64%, and robotic in 70.34%; and radical nephrectomy in 2.53%, 87.34%, and 10.13%, respectively. Incidence postoperative complications after partial and radical nephrectomy were 16.58% and 3.8%, respectively. Сomplications (Clavien —Dindo ≥ 3) occurred in 11.56% and 3.8% cases, respectively. Positive surgical margin occurred after partial nephrectomy in 1.51%, whereas undetermined for radical nephrectomy. The 5-year disease-free survival for partial and radical nephrectomy was 94.98 ± 1.77% vs. 86.96% ± 4.11%; 5-year overall survival was 96.2% ± 1.55% vs. 88.15% ± 3.96%; 10-year overall survival was 90.82% ± 4.19% vs. 76.32 ± 6.1%; and 5-year cancer-specific survival was 99.16% ± 0.84% vs. 94.09% ± 2.87%, respectively. Our study demonstrates that partial nephrectomy is a safe and effective method for surgical treatment in stage cT1 kidney cancer. A minimally invasive approach is a priority. The nephron-sparring technique demonstrates superior long-term results compared with radical nephrectomy.

Keywords

minimally invasive surgery / partial nephrectomy complications / radical nephrectomy / kidney cancer / partial nephrectomy / robot-assisted partial nephrectomy / laparoscopic partial nephrectomy / long-term results

References

[1] Aksel’ EM, Matveev VB. Statistics of malignant tumors of urinary and male urogenital organs in Russia and the countries of the former USSR. Cancer Urology. 2019;15(2):15–24. DOI: 10.17650/1726-9776-2019-15-2-15-24

[2] Аксель Е.М., Матвеев В.Б. Статистика злокачественных новообразований мочевых и мужских половых органов в России и странах бывшего СССР // Онкоурология. 2019. T. 15, № 2. С. 15–24. DOI: 10.17650/1726-9776-2019-15-2-15-24

[3] Kaprin AD, Starinskij VV, Petrova GV. Sostojanie onkologicheskoy pomoshi naseleniyu Rossii v 2017 godu. Moscow: MNIOI im. P.A. Gercena — filial FGBU "NMIRC" Minzdrava Rossii. 2018;236

[4] Каприн А.Д., Старинский В.В., Петрова Г.В. Состояние онкологической помощи населению России в 2017 году. М.: МНИОИ им. П.А. Герцена – филиал ФГБУ «НМИРЦ» Минздрава России. 2018. C. 236.

[5] Kane CJ, Mallin K, Ritchey J, et al. Renal cell cancer stage migration: analysis of the national cancer data base. Cancer. 2008;113(1):78–83. DOI: 10.1002/cncr.23518

[6] Kane C.J., Mallin K., Ritchey J., et al. Renal cell cancer stage migration: analysis of the national cancer data base // Cancer 2008. Vol. 113, No. 1. P. 78–83. DOI: 10.1002/cncr.23518

[7] Ljungberg B, Bensalah K, Canfield S, et al. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol. 2015;67(5):913–24. DOI: 10.1016/j.eururo.2015.01.005

[8] Ljungberg B., Bensalah K., Canfield S., et al. EAU guidelines on renal cell carcinoma: 2014 update // Eur Urol. 2015. Vol. 67, No. 5. P. 913–924. DOI: 10.1016/j.eururo.2015.01.005

[9] Campbell S, Uzzo RG, Allaf ME, et al. Renal mass and localized renal cancer: AUA guideline. J Urol. 2017;198(3):520–529. DOI: 10.1016/j.juro.2017.04.100

[10] Campbell S., Uzzo R.G., Allaf M.E., et al. Renal mass and localized renal cancer: AUA guideline // J Urol. 2017. Vol. 198, No. 3. P. 520–529. DOI: 10.1016/j.juro.2017.04.100

[11] Kim SP, Thompson RH, Boorjian SA, et al. Comparative effectiveness for survival and renal function of partial and radical nephrectomy for localized renal tumors: a systematic review and meta-analysis. J Urol. 2012;188(1):51–57. DOI: 10.1016/j.juro.2012.10.026

[12] Kim S.P., Thompson R.H., Boorjian S.A., et al. Comparative effectiveness for survival and renal function of partial and radical nephrectomy for localized renal tumors: a systematic review and meta-analysis // J Urol. 2012. Vol. 188, No. 1. P. 51–57. DOI: 10.1016/j.juro.2012.10.026

[13] Capitanio U, Terrone C, Antonelli A, et al. Nephron-sparing techniques independently decrease the risk of cardiovascular events relative to radical nephrectomy in patients with a T1a–T1b renal mass and normal preoperative renal function. Eur Urol. 2015;67(4):683–689. DOI: 10.1016/j.eururo.2014.09.027

[14] Capitanio U., Terrone C., Antonelli A., et al. Nephron-sparing techniques independently decrease the risk of cardiovascular events relative to radical nephrectomy in patients with a T1a–T1b renal mass and normal preoperative renal function // Eur Urol. 2015. Vol. 67, No. 4. P. 683–689. DOI: 10.1016/j.eururo.2014.09.027

[15] Wang DC, Plante K, Stewart T, et al. Comparison of survival for partial vs. radical nephrectomy in young patients with T1a renal cell carcinoma treated at commission on cancer-accredited facilities and influence of comorbidities on treatment choice. Urol Oncol. 2017;35(11):660.e9–660.e15. DOI: 10.1016/j.urolonc.2017.06.056

[16] Wang D.C., Plante K., Stewart T., et al. Comparison of survival for partial vs. radical nephrectomy in young patients with T1a renal cell carcinoma treated at commission on cancer-accredited facilities and influence of comorbidities on treatment choice // Urol Oncol. 2017. Nov. Vol. 35, No. 11. P. 660.e9–660.e15. DOI: 10.1016/j.urolonc.2017.06.056

[17] Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(11):1296–1305. DOI: 10.1056/NEJMoa041031

[18] Go A.S., Chertow G.M., Fan D., et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization // N Engl J. Med. 2004. Vol. 351, No. 13. P. 1296–1305. DOI: 10.1056/NEJMoa041031

[19] Rakul CA, Romashchenko PN, Pozdnyakov KV, et al. Minimally invasive technologies for surgical treatment of kidney cancer. Grekov’s Bulletin of Surgery. 2020;179(6):34–43. DOI: 10.24884/0042-4625-2020-179-6-34-43

[20] Ракул C.А., Ромащенко П.Н., Поздняков К.В., и др. Малоинвазивные технологии хирургического лечения рака почки // Вестник хирургии имени И.И. Грекова. 2020. Т. 179, № 6. С. 34–43. DOI: 10.24884/0042-4625-2020-179-6-34-43

[21] Cacciamani GE, Medina LG, Gill T, et al. Impact of surgical factors on robotic partial nephrectomy outcomes: comprehensive systematic review and meta-analysis. J Urol. 2018;200(2):258–274. DOI: 10.1016/j.juro.2017.12.086

[22] Cacciamani G.E., Medina L.G., Gill T., et al. Impact of surgical factors on robotic partial nephrectomy outcomes: comprehensive systematic review and meta-analysis // J Urol. 2018. Vol. 200, No. 2. P. 258–274. DOI: 10.1016/j.juro.2017.12.086

[23] Hjelle KM, Johannesen TB, Bostad L, et al. National Norwegian practice patterns for surgical treatment of kidney cancer tumors ≤ 7cm: adherence to changes in guidelines may improve overall survival. Eur Urol Oncol. 2018;1(3):252–261. DOI: 10.1016/j.euo.2018.04.001

[24] Hjelle K.M., Johannesen T.B., Bostad L., et al. National norwegian practice patterns for surgical treatment of kidney cancer tumors ≤ 7cm: adherence to changes in guidelines may improve overall survival // Eur Urol Oncol. 2018. Vol. 1, No. 3. P. 252–261. DOI: 10.1016/j.euo.2018.04.001

[25] Mari A, Di Maida F, Brunocilla E, et al. A snapshot of nephron sparing surgery in Italy: a prospective, multicenter report on clinical and operative data (the record 2 project). European Urology Supplements. 2019;18(9):e3158–e3359. DOI: 10.1016/S1569-9056(19)33486-4

[26] Mari A., Di Maida F., Brunocilla E., et al. A snapshot of nephron sparing surgery in Italy: a prospective, multicenter report on clinical and operative data (the record 2 project) // European Urology Supplements. 2019. Vol. 18, № 9. P. e3158–e3359. DOI: 10.1016/S1569-9056(19)33486-4

[27] Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien – Dindo classification of surgical complications: five year experience. Ann Surg. 2009;250(2):187–196. DOI: 10.1097/SLA.0b013e3181b13ca2

[28] Clavien P.A., Barkun J., de Oliveira M.L., et al. The Clavien — Dindo classification of surgical complications: five year experience // Ann Surg. 2009. Vol. 250, No. 2. P. 187–196. DOI: 10.1097/SLA.0b013e3181b13ca2

[29] Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol. 2009;182(3):844–853. DOI: 10.1016/j.juro.2009.05.035

[30] Kutikov A., Uzzo R.G. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth // J Urol. 2009. Vol. 182, No. 3. P. 844–853. DOI: 10.1016/j.juro.2009.05.035

[31] Gershman B, Thompson RH, Boorjian SA, et al. Radical Versus Partial Nephrectomy for cT1 Renal Cell Carcinoma. Eur Urol. 2018;74(6):825–832. DOI: 10.1016/j.eururo.2018.08.028

[32] Gershman B., Thompson R.H., Boorjian S.A., et al. Radical Versus Partial Nephrectomy for cT1 Renal Cell Carcinoma // Eur Urol. 2018. Vol. 74, No. 6. P. 825–832. DOI: 10.1016/j.eururo.2018.08.028

[33] Furukawa J, Ka nayama H, Azuma H, et al. "Trifecta@ outcomes of robot-assisted partial nephrectomy: a large Japanese multicenter study. J Clin Oncol. 2020;25(2):347–353. DOI: 10.1007/s10147-019-01565-0

[34] Furukawa J., Kanayama H., Azuma H., et. al. "Trifecta" outcomes of robot-assisted partial nephrectomy: a large Japanese multicenter study // J Clin Oncol. 2020. Vol. 25, No. 2. P. 347–353. DOI: 10.1007/s10147-019-01565-0

[35] Connor J, Doppalapudi S, Wajswol E, et al. Postoperative complications after robotic partial nephrectomy. J Endourol. 2020;34(1):42–47. DOI: 10.1089/end.2019.0434

[36] Connor J., Doppalapudi S., Wajswol E., et al. Postoperative complications after robotic partial nephrectomy // J Endourol. 2020. Vol. 34, No. 1. P. 42–47. DOI: 10.1089/end.2019.0434

[37] Hadjipavlou M, Khan F, Fowler S, et al. Partial vs radical nephrectomy for T1 renal tumors: an analysis from the British association of urological surgeons nephrectomy audit. BJU Int. 2016;117(1):62–71. DOI: 10.1111/bju.13114

[38] Hadjipavlou M., Khan F., Fowler S., et al. Partial vs radical nephrectomy for T1 renal tumors: an analysis from the British association of urological surgeons nephrectomy audit // BJU Int. 2016. Vol. 117, No. 1. P. 62–71. DOI: 10.1111/bju.13114

[39] Janssen M, Linxweiler J, Terwey S, et al. Survival outcomes in patients with large (≥ 7cm) clear cell renal cell carcinomas treated with nephron-sparing surgery versus radical nephrectomy: results of a multicenter cohort with long-term follow-up. PLoS One. 2018;13(5):e0196427. DOI: 10.1371/journal.pone.0196427

[40] Janssen M., Linxweiler J., Terwey S., et al. Survival outcomes in patients with large (≥ 7cm) clear cell renal cell carcinomas treated with nephron-sparing surgery versus radical nephrectomy: results of a multicenter cohort with long-term follow-up // PLoS One. 2018. Vol. 13, No. 5. P. e0196427. DOI: 10.1371/journal.pone.0196427

[41] Hamilton ZA, Capitanio U, Pruthi D, et al. Risk factors for upstaging, recurrence, and mortality in clinical T1-2 renal cell carcinoma patients upstaged to pT3a disease: an international analysis utilizing the 8th edition of the tumor-node-metastasis staging criteria. Urology. 2020;138:60–68. DOI: 10.1016/j.urology.2019.11.036

[42] Hamilton Z.A., Capitanio U., Pruthi D., et al. Risk factors for upstaging, recurrence, and mortality in clinical T1-2 renal cell carcinoma patients upstaged to pT3a disease: an international analysis utilizing the 8th edition of the tumor-node-metastasis staging criteria // Urology. 2020. Vol. 138. P. 60–68. DOI: 10.1016/j.urology.2019.11.036

[43] Bertolo R, Garisto J, Dagenais J, et al. Transperitoneal robot-assisted partial nephrectomy with minimum follow-up of 5-years: oncological and functional outcomes from a single institution. Eur Oncol. 2019;2(2):207–213. DOI: 10.1016/j.euo.2018.06.012

[44] Bertolo R., Garisto J., Dagenais J., et al. Transperitoneal robot-assisted partial nephrectomy with minimum follow-up of 5-years: oncological and functional outcomes from a single institution // Eur Oncol. 2019. Vol. 2, No. 2. P. 207–213. DOI: 10.1016/j.euo.2018.06.012

[45] Cai Y, Li HZ, Zhang YS, et al. Comparison of partial and radical laparoscopic nephrectomy: long-term outcomes for clinical T1b renal cell carcinoma. Urol J. 2018;15(2):16–20. DOI: 10.22037/uj.v0i0.3913

[46] Cai Y., Li H.Z., Zhang Y.S., et al. Comparison of partial and radical laparoscopic nephrectomy: long-term outcomes for clinical T1b renal cell carcinoma // Urol J. 2018. Vol. 15, No. 2. P. 16–20. DOI: 10.22037/uj.v0i0.3913

[47] Koo KC, Kim JC, Cho KS, et al. Oncological outcomes after partial vs radical nephrectomy in renal cell carcinomas of ≤ 7 cm with presumed renal sinus fat invasion on preoperative imaging. BJU Int. 2016;117(1):87–93. DOI: 10.1111/bju.12893

[48] Koo K.C., Kim J.C., Cho K.S., et al. Oncological outcomes after partial vs radical nephrectomy in renal cell carcinomas of ≤ 7 cm with presumed renal sinus fat invasion on preoperative imaging // BJU Int. 2016. Vol. 117, No. 1. P. 87–93. DOI: 10.1111/bju.12893

[49] Beauval JB, Peyronnet B, Benoit T, et al. Long-term oncological outcomes after robotic partial nephrectomy for renal cell carcinoma: a prospective multicentre study. World J Urol. 2018;36(6):897–904. DOI: 10.1007/s00345-018-2208-8

[50] Beauval J.B., Peyronnet B., Benoit T., et al. Long-term oncological outcomes after robotic partial nephrectomy for renal cell carcinoma: a prospective multicentre study // World J Urol. 2018. Vol. 36, No. 6. P. 897–904. DOI: 10.1007/s00345-018-2208-8

[51] Jang HA, Kim JW, Byun SS, et al. Oncologic and Functional Outcomes after Partial Nephrectomy Versus Radical Nephrectomy in T1b Renal Cell Carcinoma: A Multicenter, Matched Case-Control Study in Korean Patients. Cancer Res Treat. 2016;48(2):612–620. DOI: 10.4143/crt.2014.122

[52] Jang H.A., Kim J.W., Byun S.S., et al. Oncologic and Functional Outcomes after Partial Nephrectomy Versus Radical Nephrectomy in T1b Renal Cell Carcinoma: A Multicenter, Matched Case-Control Study in Korean Patients // Cancer Res Treat. 2016. Vol. 48, No. 2. P. 612–620. DOI: 10.4143/crt.2014.122

RIGHTS & PERMISSIONS

Rakul S.A., Romashchenko P.N., Pozdnyakov K.V., Maistrenko N.A.