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Andrew C Novick - One of the best experts on this subject based on the ideXlab platform.

  • the impact of ischemia time during open Nephron Sparing Surgery on solitary kidneys a multi institutional study
    The Journal of Urology, 2007
    Co-Authors: Houston R Thompson, Bradley C. Leibovich, Michael L. Blute, Horst Zincke, Christine M Lohse, Igor Frank, Ismail R Saad, Amr Fergany, Andrew C Novick
    Abstract:

    Purpose: The safe duration of ischemia during Nephron Sparing Surgery remains controversial. We performed a multi-institutional study to evaluate the renal effects of vascular clamping in patients with solitary kidneys.Materials and Methods: Using the Cleveland Clinic and Mayo Clinic databases, we identified 537 patients with solitary kidneys who underwent open Nephron Sparing Surgery. Renal complications were compared among patients who did not require vascular clamping (85), and those who had warm ischemia (174) and cold ischemia (278).Results: Median patient age (63, 65, 64 years) and preoperative creatinine (1.4, 1.3, 1.4 mg/dl) were similar among patients with no ischemia, warm ischemia and cold ischemia, respectively. Median tumor size was smaller in patients with no ischemia (2.5 cm), compared to patients with warm (3.5 cm) and cold (4.0 cm) ischemia (p <0.001). Warm and cold ischemia was associated with a significantly increased risk of urine leak (p = 0.006), acute (p <0.001) and chronic (p = 0.0...

  • Nephron Sparing Surgery for renal cell carcinoma
    Cancer treatment and research, 2003
    Co-Authors: Andrew C Novick
    Abstract:

    Recent interest in Nephron-Sparing Surgery for renal cell carcinoma has been stimulated by advances in renal imaging, improved surgical techniques, the increasing number of incidentally discovered low-stage renal cell carcinomas and good long-term survival in patients undergoing this form of treatment [1]. Nephron-Sparing Surgery entails complete local excision of a renal tumor while leaving the largest possible amount of normal functioning parenchyma in the involved kidney.

  • Nephron Sparing Surgery for renal cell carcinoma
    Annual Review of Medicine, 2002
    Co-Authors: Andrew C Novick
    Abstract:

    Nephron-Sparing Surgery (NSS) provides effective curative therapy for patients with localized renal cell carcinoma. In patients with imperative indications, it represents an alternative to renal replacement therapy. For selected patients with systemic comorbidities that threaten global renal function, NSS preserves unaffected Nephrons with excellent cancer-specific survival. Elective partial nephrectomy for patients with a small (< or = 4 cm), unifocal tumor and a normal contralateral kidney is associated with a low risk (0%-3%) of local recurrence and cancer-specific survival rates of 90%-100%. Comparisons between radical and partial nephrectomy demonstrate equivalent cancer control over five years. Minimally invasive techniques of NSS are feasible but await improved technologies and long-term outcome data before they become fully acceptable treatment options.

  • Nephron Sparing Surgery for renal tumors indications techniques and outcomes
    The Journal of Urology, 2001
    Co-Authors: Robert G Uzzo, Andrew C Novick
    Abstract:

    Purpose: A contemporary review of the indications, techniques and outcomes is presented for Nephron Sparing approaches to solid renal masses, emphasizing their role for the treatment of renal cell carcinoma. We also reviewed the evolving role of minimally invasive forms of parenchymal Sparing renal Surgery.Materials and Methods: MEDLINE and CANCERLIT computerized literature searches, and manual bibliographic reviews were performed to identify published peer reviewed articles pertaining to Nephron Sparing Surgery or partial nephrectomy from 1980 to 2000. Pertinent articles were collated and reviewed.Results: Nephron Sparing Surgery is increasingly being used to treat patients with solid renal lesions. The technical success rate of Nephron Sparing Surgery is excellent, and operative morbidity and mortality are low. For renal cell carcinoma long-term cancer-free survival is comparable to that after radical nephrectomy, particularly for low stage disease. The overall incidence of local recurrence is low at 0%...

  • long term results of Nephron Sparing Surgery for localized renal cell carcinoma 10 year followup
    The Journal of Urology, 2000
    Co-Authors: Amr Fergany, Khaled S Hafez, Andrew C Novick
    Abstract:

    Purpose: Partial nephrectomy is effective for renal cell carcinoma when preservation of renal function is a concern. We present the 10-year followup of patients treated with Nephron Sparing Surgery at our institution.Materials and Methods: Partial nephrectomy was performed in 107 patients with localized sporadic renal cell carcinoma before December 1988. Tumors were symptomatic in 73 patients (68%) and indications for Surgery were imperative in 96 (90%). Of the patients 42 (39%) had renal insufficiency preoperatively. All patients were followed a minimum of 10 years or until death.Results: At the end of the followup interval 32 patients (30%) had no evidence of recurrence, 28 (26%) died of metastatic renal cell carcinoma and 46 (42%) died of unrelated causes. Cancer specific survival was 88.2% at 5 and 73% at 10 years, and was significantly affected by tumor stage, symptoms, tumor laterality and tumor size. Long-term renal function was stable in 52 patients (49%).Conclusions: Partial nephrectomy is effect...

Mark R Licht - One of the best experts on this subject based on the ideXlab platform.

  • management of small unilateral renal cell carcinomas radical versus Nephron Sparing Surgery
    Urology, 1995
    Co-Authors: Brian P Butler, Andrew C Novick, David P Miller, Steven A Campbell, Mark R Licht
    Abstract:

    Objectives. There is controversy concerning the management of small unilateral renal cell carcinomas. The present study was undertaken to evaluate the relative efficacy of radial nephrectomy versus Nephron-Sparing Surgery in such patients.

  • management of small unilateral renal cell carcinomas radical versus Nephron Sparing Surgery
    Urology, 1995
    Co-Authors: Brian P Butler, Andrew C Novick, David P Miller, Steven A Campbell, Mark R Licht
    Abstract:

    Abstract Objectives. There is controversy concerning the management of small unilateral renal cell carcinomas. The present study was undertaken to evaluate the relative efficacy of radial nephrectomy versus Nephron-Sparing Surgery in such patients. Methods. Patients with a single, small (less than 4 cm), localized, unilateral, sporadic renal cell carcinoma (IRCC) were identified from an institutional registry. From 1975 to 1992, 88 patients fulfilling these criteria were treated with either radical nephrectomy (n = 42) or Nephron-Sparing Surgery (n = 46). The mean postoperative follow-up interval is 48 ± 29 months. Results. The radical and Nephron-Sparing surgical groups were well matched for patient age, sex, renal function, diabetes, hypertension, tumor size, tumor location, and tumor stage. All patients in both groups had low pathologic stage RCC. There was no difference between the two groups in terms of the mean hospital stay, the requirement for blood transfusions, or the occurrence of surgical complications. There was no difference in the mean preoperative and postoperative serum creatinine levels for patients in the Nephron-Sparing Surgery group. However, the mean postoperative serum creatinine levels were significantly higher than the mean preoperative levels for patients in the radical nephrectomy group (P Conclusions. Radical nephrectomy and Nephron-Sparing Surgery each provide safe and effective curative treatment for patients with a single, small, unilateral localized RCC. The long-term renal functional advantage of Nephron-Sparing Surgery in this setting is not established.

  • Nephron Sparing Surgery in incidental versus suspected renal cell carcinoma
    The Journal of Urology, 1994
    Co-Authors: Mark R Licht, Andrew C Novick, Marlene Goormastic
    Abstract:

    AbstractFrom 1956 to 1992 Nephron Sparing Surgery was performed in 216 patients with sporadic renal cell carcinoma. Renal cell carcinoma was suspected in 121 patients and was an incidental finding in 95. Compared to suspected renal cell carcinoma, incidental tumors were smaller (p = 6.0004), more often unilateral (p = 0.001) and of lower pathological stage (p = 0.001). Incidental tumors were also associated with improved 5-year cancer-specific survival (p = 0.003) and a lower rate of postoperative tumor recurrence (p = 0.001).The overall 5-year cancer-specific survival rate was improved in patients with stage I versus higher stage renal cell carcinoma (p = 0.0002), unilateral versus bilateral disease (p = 0.0001), a single versus multiple tumors in the operated kidney (p = 0.01) and tumors smaller than 4cm. versus larger tumors (p = 0.03). There were no postoperative tumor recurrences and the 5-year cancer-specific survival rate was 100% in patients with unilateral, stage I tumors smaller than 4cm. These ...

  • Nephron Sparing Surgery for renal cell carcinoma
    The Journal of Urology, 1993
    Co-Authors: Mark R Licht, Andrew C Novick
    Abstract:

    Nephron-Sparing Surgery has become an established surgical treatment for patients with renal cell carcinoma (RCC), particularly in situations in which preservation of renal parenchyma is critical. However, due to the fear of local renal fossa recurrence with Nephron-Sparing Surgery, radical nephrectomy has historically been the treatment of choice for patients with unilateral RCC and a normal contralateral kidney. Recently, increased incidence of low-stage, localized, solitary RCC has led to renewed interest in partial nephrectomy. With excellent disease-specific survival and recurrence rates comparable to that achieved with radical nephrectomy, Nephron-Sparing Surgery can be confidently utilized in treating patients with stage T1 RCC lesions (<7 cm) and a normal contralateral kidney. The utility of Nephron-Sparing Surgery in the context of adjunctive systemic immunotherapy remains to be explored.

Inderbir S. Gill - One of the best experts on this subject based on the ideXlab platform.

  • the subclassification of papillary renal cell carcinoma does not affect oncological outcomes after Nephron Sparing Surgery
    World Journal of Urology, 2016
    Co-Authors: P Bigot, Inderbir S. Gill, Jeanchristophe Bernhard, Nam Son Vuong, G Verhoest, V Flamand, B Reix, Evren Suer, Ilker Gokce, Jean Baptiste Beauval
    Abstract:

    Objectives To evaluate the oncological outcomes of papillary renal cell carcinoma (pRCC) following Nephron Sparing Surgery (NSS) and to determine whether the subclassification type of pRCC could be a prognostic factor for recurrence, progression, and specific death.

  • The subclassification of papillary renal cell carcinoma does not affect oncological outcomes after Nephron Sparing Surgery
    World Journal of Urology, 2016
    Co-Authors: P Bigot, Inderbir S. Gill, Jeanchristophe Bernhard, Nam Son Vuong, G Verhoest, V Flamand, B Reix, Evren Suer, Ilker Gokce, Jean Baptiste Beauval
    Abstract:

    Objectives To evaluate the oncological outcomes of papillary renal cell carcinoma (pRCC) following Nephron Sparing Surgery (NSS) and to determine whether the subclassification type of pRCC could be a prognostic factor for recurrence, progression, and specific death. Materials and methods An international multicentre retrospective study involving 19 institutions and the French network for research on kidney cancer was conducted after IRB approval. We analyzed data of all patients with pRCC who were treated by NSS between 2004 and 2014. Results We included 486 patients. Tumors were type 1 pRCC in 369 (76 %) cases and type 2 pRCC in 117 (24 %) cases. After a mean follow-up of 35 (1–120) months, 8 (1.6 %) patients experienced a local recurrence, 12 (1.5 %) had a metastatic progression, 24 (4.9 %) died, and 7 (1.4 %) died from cancer. Patients with type I pRCC had more grade II (66.3 vs. 46.1 %; p \textless 0.001) and less grade III (20 vs. 41 %; p \textless 0.001) tumors. Three-year estimated cancer-free survival (CFS) rate for type 1 pRCC was 96.5 % and for type 2 pRCC was 95.1 % (p = 0.894), respectively. Three-year estimated cancer-specific survival rate for type 1 pRCC was 98.4 % and for type 2 pRCC was 97.3 % (p = 0.947), respectively. Tumor stage superior to pT1 was the only prognostic factor for CFS (HR 3.5; p = 0.03). Conclusion Histological subtyping of pRCC has no impact on oncologic outcomes after Nephron Sparing Surgery. In this selected population of pRCC tumors, we found that tumor stage is the only prognostic factor for cancer-free survival

  • mp63 15 the subclassification of papillary renal cell carcinoma does not affect oncological outcomes after Nephron Sparing Surgery
    The Journal of Urology, 2015
    Co-Authors: P Bigot, Inderbir S. Gill, Jeanchristophe Bernhard, G Verhoest, B Reix, Evren Suer, Masatoshi Eto, Francois Xavier Nouhaud, Vincent Flammand, Ilker Gokce
    Abstract:

    Objectives To evaluate the oncological outcomes of papillary renal cell carcinoma (pRCC) following Nephron Sparing Surgery (NSS) and to determine whether the subclassification type of pRCC could be a prognostic factor for recurrence, progression, and specific death.

  • Minimally invasive Nephron-Sparing Surgery.
    Current opinion in urology, 2008
    Co-Authors: Andre Berger, Sebastien Crouzet, David Canes, Georges-pascal Haber, Inderbir S. Gill
    Abstract:

    Purpose of reviewTo review the evolution and current status of minimally invasive Nephron-Sparing Surgery for renal tumors.Recent findingsMinimally invasive Nephron-Sparing Surgery for renal tumors encompasses extirpative laparoscopic partial nephrectomy and ablative procedures such as cryoablation,

  • minimally invasive Nephron Sparing Surgery minss for renal tumours part ii probe ablative therapy
    European Urology, 2007
    Co-Authors: Monish Aron, Inderbir S. Gill
    Abstract:

    Abstract Objectives To review the evolution and current status of probe ablative methods of minimally invasive Nephron-Sparing Surgery (MINSS) for renal tumours. Methods The English language literature of the past 10 yr was reviewed by using the National Library of Medicine database and the following keywords: chemoablation, cryoablation, high-intensity focused ultrasound, kidney, laser interstitial thermotherapy, microwave thermotherapy, Nephron-Sparing Surgery, radiofrequency ablation, radioSurgery, renal, and tumour. Over 300 papers were identified, 50 of which were selected for this review on the basis of their contribution in advancing the field with regards to (1) evolution of concepts, (2) development and refinement of techniques, and (3) intermediate- and long-term clinical outcomes. Results Open partial nephrectomy is the reference standard for Nephron-Sparing Surgery against which all MINSS techniques should be measured. Although the initial outcomes of cryoablation and radiofrequency ablation (RFA) are encouraging, long-term studies are necessary to confirm lasting efficacy. The optimal modality for tumour targeting, monitoring therapy, and follow-up remains to be determined. These ablative techniques should be reserved for carefully selected patients, the data should be prospectively accrued, and the long-term cancer cure rates should be compared with the reference standard. Conclusions Promising long-term data are available for cryoablation. RFA is still considered developmental, and instances of incomplete cell kill, despite nonenhancement, are concerning. Other modalities are still experimental.

Joachim W. Thüroff - One of the best experts on this subject based on the ideXlab platform.

  • elective Nephron Sparing Surgery for renal cell carcinoma larger than 4 cm
    The Journal of Urology, 2008
    Co-Authors: Sascha Pahernik, Chistoph Wiesner, F C Roos, Bernd Rohrig, Joachim W. Thüroff
    Abstract:

    Purpose: Elective Nephron Sparing Surgery is established as an alternative to radical nephrectomy for renal cell carcinoma if tumors are small (4 cm or less, stage T1a). We compared outcomes in patients with renal cell carcinoma 4 cm or less (small) vs more than 4 cm (large) who were treated with Nephron Sparing Surgery.Materials and Methods: Between 1979 and 2006, 618 patients underwent elective Nephron Sparing Surgery at our institution. Of these patients 474 (76.7%) had renal cell carcinoma, which was 4 cm or less in 372 (78.5%) and more than 4 cm in 102 (21.5%). Followup was 4.7 (range 0.1 to 23.9) years for small and 4.7 (range 0.1 to 24.1) years for large tumors. Cancer specific survival and local recurrence free survival were estimated.Results: The estimated cancer specific survival rate at 5 years was 97.9% and 95.8%, and at 10 years it was 94.9% and 95.8% for small and large tumors, respectively (log rank p = 0.583). The survival rate free of local recurrence at 5 years was 98.5% and 98.3%, and a...

  • Nephron Sparing Surgery for renal cell carcinoma in a solitary kidney
    World Journal of Urology, 2007
    Co-Authors: Sascha Pahernik, Frederik Roos, Chistoph Wiesner, Joachim W. Thüroff
    Abstract:

    To determine functional and oncological outcomes of Nephron Sparing Surgery (NSS) for renal cell carcinoma (RCC). We identified from our kidney database 103 consecutive patients undergoing NSS for solid renal tumors in a solitary kidney. After excluding 17 patients (16.5%) undergoing NSS with palliative intent in presence of preoperatively diagnosed metastatic disease ( n  = 15) or positive lymph nodes ( n  = 2) and 6 patients (5.8%) who turned out to have benign tumors, the remaining 80 patients with RCC were analyzed. Mean follow-up is 8.0 years (range: 0.1–25.8). Mean tumor size was 4.2 cm (range 1.2–11 cm). Chronic renal failure requiring hemodialysis developed after NSS in nine patients (11.2%). In the remainder, serum creatinine was 1.72 mg/dl (range: 0.45–4.6 mg/dl) at latest follow-up. The cancer specific survival rates at 1, 5 and 10 years were 97.2, 89.6 and 76%, respectively. The estimated local recurrence free survival rates at 1, 5 and 10 years were 97.8, 89.4 and 79.9%, respectively. Univariate analysis of correlation between clinical and pathologic features with death from RCC showed significant associations for grading and tumor size. The long-term data of our series support the concept of organ-Sparing Surgery for RCC in a solitary kidney since it provides excellent local tumor control and cancer specific survival and preserves renal function renal function so that 89% of patients remained free of dialysis in the long-run.

  • Nephron Sparing Surgery of renal cell carcinoma with a normal opposite kidney long term outcome in 180 patients
    Urology, 2000
    Co-Authors: D Filipas, Peter C Black, J Fichtner, Rudolf Hohenfellner, Claudia Spix, Wolfgang Carus, Joachim W. Thüroff
    Abstract:

    Abstract Objectives. To investigate the long-term outcome of an organ-saving approach for renal cell carcinoma (RCC) with a normal opposite kidney (elective indication). Methods. Since 1979, 180 patients have undergone Nephron-Sparing Surgery at our institution for RCC in the presence of a normal contralateral kidney. The mean age was 56 years (range 23 to 83), and the mean follow-up was 4.7 years (maximum 14.8). Most of these tumors were found incidentally, with a mean tumor diameter on ultrasound of 3.3 cm (range 1.0 to 8.6). Results. The postoperative course was unremarkable in 173 patients. Postoperative bleeding was encountered in 4 patients and urinary extravasation in an additional 3 patients. No surgical reintervention was necessary. One hundred seventy-five RCCs were pT1 and 5 were pT3a; 73 were grade 1, 100 grade 2, and 7 were grade 3. The mean tumor diameter (surgical specimen) was 3.2 cm (range 0.5 to 7). In 132 cases, the tumor was less than 4 cm and in 48 cases, greater than 4 cm. Three patients experienced local tumor recurrence (1.6%) during follow-up, and two others developed distant metastases. The 5-year tumor-specific survival rate was 98.0%. Conclusions. Nephron-Sparing Surgery for RCC under an elective indication in selected patients offers excellent long-term survival and an acceptably low local tumor recurrence rate. These results support the concept of Nephron-Sparing Surgery in the presence of a normal contralateral kidney.

  • Nephron Sparing Surgery for central renal tumors experience with 33 cases
    The Journal of Urology, 2000
    Co-Authors: Peter C Black, D Filipas, J Fichtner, Rudolf Hohenfellner, Joachim W. Thüroff
    Abstract:

    Purpose: Nephron Sparing Surgery is standard treatment for small, peripherally located renal cell carcinoma. In patients with a solitary kidney, bilateral tumors or impaired renal function Nephron Sparing Surgery provides the only option to nephrectomy and subsequent hemodialysis or transplantation. We retrospectively investigated the value of Nephron Sparing Surgery for centrally located renal cell carcinoma. Materials and Methods: Between 1969 and 1997, 311 renal tumor enucleations were performed at our institution. The tumor was centrally located in 33 cases. The indication for enucleation was elective in 7 cases and imperative in 26, including bilateral tumor in 16 (metachronous in 9 and synchronous in 7), chronic renal failure in 4 and solitary kidney in 6. Four patients had metastasis at enucleation. Results: Convalescence was unremarkable in 28 cases. Hemorrhage occurred in 1 patient, a urinary fistula in 2 and a local abscess secondary to a urinary fistula in 1. One patient died postoperatively of heart failure. Average serum creatinine was 1.25, 1.63 and 1.33 mg./dl. preoperatively, at hospital discharge and at a mean followup of 33 months, respectively. Hemodialysis was necessary transiently during convalescence in 1 patient and permanently starting 6 years after enucleation in another. Definitive histology revealed oncocytoma in 4 cases and renal cell carcinoma in 29. Disease was stages pT1 to pT3 in 9, 18 and 2 cases, and grades 1 to 3 in 6, 18 and 5, respectively. Local recurrence developed in 2 patients. Mean followup was 5.2 years (range 0.3 to 16.7). At a mean followup of 6.2 years (range 0.7 to 16.7) 20 patients were free of disease. In addition to the patient who died postoperatively, 9 died of renal cell carcinoma at a mean of 1.6 years (range 0.3 to 5.3) and 3 died of other causes at 5, 11 and 12 years postoperatively, respectively. No patient who underwent elective enucleation died. Conclusions: Nephron Sparing Surgery for centrally located kidney tumors is technically feasible and associated with an acceptable complication rate. Local tumor control is excellent, and the overall prognosis depends on contralateral disease and metastasis. Benign tumors may be diagnosed and removed without loss of the kidney. By avoiding hemodialysis quality of life is improved.

Michael L. Blute - One of the best experts on this subject based on the ideXlab platform.

  • the impact of ischemia time during open Nephron Sparing Surgery on solitary kidneys a multi institutional study
    The Journal of Urology, 2007
    Co-Authors: Houston R Thompson, Bradley C. Leibovich, Michael L. Blute, Horst Zincke, Christine M Lohse, Igor Frank, Ismail R Saad, Amr Fergany, Andrew C Novick
    Abstract:

    Purpose: The safe duration of ischemia during Nephron Sparing Surgery remains controversial. We performed a multi-institutional study to evaluate the renal effects of vascular clamping in patients with solitary kidneys.Materials and Methods: Using the Cleveland Clinic and Mayo Clinic databases, we identified 537 patients with solitary kidneys who underwent open Nephron Sparing Surgery. Renal complications were compared among patients who did not require vascular clamping (85), and those who had warm ischemia (174) and cold ischemia (278).Results: Median patient age (63, 65, 64 years) and preoperative creatinine (1.4, 1.3, 1.4 mg/dl) were similar among patients with no ischemia, warm ischemia and cold ischemia, respectively. Median tumor size was smaller in patients with no ischemia (2.5 cm), compared to patients with warm (3.5 cm) and cold (4.0 cm) ischemia (p <0.001). Warm and cold ischemia was associated with a significantly increased risk of urine leak (p = 0.006), acute (p <0.001) and chronic (p = 0.0...

  • the role of Nephron Sparing Surgery for metastatic pm1 renal cell carcinoma
    The Journal of Urology, 2006
    Co-Authors: Amy E Krambeck, Bradley C. Leibovich, Horst Zincke, Christine M Lohse, Eugene D Kwon, Michael L. Blute
    Abstract:

    Purpose: Studies have demonstrated increased time to progression when cytoreductive nephrectomy is performed for metastatic renal cell carcinoma. We evaluated the role of Nephron Sparing Surgery in these patients.Materials and Methods: We selected all patients with pM1 renal cell carcinoma treated with Nephron Sparing Surgery or radical nephrectomy, and all patients with pM0 renal cell carcinoma undergoing Nephron Sparing Surgery for solitary kidney from 1970 to 2002 from the Mayo Clinic Nephrectomy Registry.Results: We identified 16 patients who underwent Nephron Sparing Surgery for pM1 renal cell carcinoma. Solitary kidney was present in 12, 3 had bilateral synchronous disease and 1 had elective Nephron Sparing Surgery. Cancer specific survival rates at 1, 3 and 5 years were 81%, 49% and 49%, respectively. We identified 404 patients who underwent radical nephrectomy for pM1 renal cell carcinoma. Cancer specific survival rates at 1, 3 and 5 years were 51%, 21% and 13%, respectively. The pM1 Nephron spari...

  • complications of contemporary open Nephron Sparing Surgery a single institution experience
    The Journal of Urology, 2005
    Co-Authors: Houston R Thompson, Bradley C. Leibovich, Horst Zincke, Christine M Lohse, Michael L. Blute
    Abstract:

    ABSTRACTPurpose: Open Nephron Sparing Surgery (NSS) is now the standard of care for small renal tumors irrespective of overall renal function. More recently laparoscopic NSS with hilar clamping has emerged, albeit with relatively longer ischemic times. We reviewed our experience with contemporary open NSS, comparing complication rates to those of historical controls and updating data for comparison with minimally invasive procedures.Materials and Methods: From 1985 to 2001, 823 open NSSs were performed at our institution. Early (within 30 days of NSS) and late (30 days to 1 year) complications were compared using the chi-square and Wilcoxon rank sum tests between procedures performed in 1985 to 1995 (control group of 343 patients) and 1996 to 2001 (contemporary group of 480).Results: In the control vs the contemporary group there were significant decreases in intraoperative blood loss (median 550 vs 350 cc, p <0.001), chronic renal insufficiency/failure (14.6% vs 8.1%, p = 0.003), dialysis need (7.0% vs 2...

  • Nephron Sparing Surgery for renal cell carcinoma clinicopathologic features predictive of patient outcome
    Urology, 2003
    Co-Authors: Kent G Krejci, Michael L. Blute, Christine M Lohse, John C Cheville, Thomas J Sebo, Horst Zincke
    Abstract:

    Abstract Objectives To determine the clinicopathologic features associated with outcome in patients with sporadic renal cell carcinoma (RCC) treated with Nephron-Sparing Surgery. Methods We studied 344 patients treated with Nephron-Sparing Surgery between 1970 and 2000. The pathologic features of the tumors were reviewed by two urologic pathologists who recorded the histologic subtype, 2003 TNM stage, tumor size, and grade. Cancer-specific survival (CSS) was estimated using the Kaplan-Meier method, and log-rank tests were used to compare the outcome by histologic subtype. Univariate Cox proportional hazards models were fit to assess the associations between the clinicopathologic features and death from RCC, distant metastases, and local recurrence. Results The CSS rate at 5 and 10 years for patients with clear cell RCC was 94.4% and 91.5%, respectively. In contrast, the CSS rate at 5 and 10 years for patients with papillary or chromophobe RCC was 99.0%, because only 1 patient died of papillary RCC and no patient died of chromophobe RCC ( P = 0.029). Among the patients with localized clear cell RCC, tumor stage and grade were significantly associated with death from RCC and metastases. Grade was significantly associated with local recurrence for clear cell RCC, but not for papillary RCC. Conclusions In our series of patients with RCC treated with Nephron-Sparing Surgery, patients with clear cell RCC had a significantly worse CSS than did patients with papillary and chromophobe RCC. Tumor stage and grade were associated with outcome among patients with localized clear cell RCC. These findings are similar to the results for patients with localized clear cell RCC treated with radical nephrectomy.

  • multiple ipsilateral renal tumors discovered at planned Nephron Sparing Surgery importance of tumor histology and risk of metachronous recurrence
    The Journal of Urology, 2003
    Co-Authors: Michael L. Blute, Gregory Thibault, Bradley C. Leibovich, Christine M Lohse, John C Cheville, Horst Zincke
    Abstract:

    ABSTRACTPurpose: Unrecognized sporadic multifocality at planned Nephron Sparing Surgery (NSS) presents a surgical dilemma. We report a single institution experience with patients presenting with multiple ipsilateral renal tumors, of which at least 1 was renal cell carcinoma (RCC). We determined the outcome for patients treated with NSS or radical nephrectomy (RN).Materials and Methods: A total of 118 patients underwent Surgery between 1970 and 2000 for sporadic multiple ipsilateral renal tumors, of which at least 1 was RCC. The patients were treated with RN (102) and NSS (16). Clinical features recorded included age at Surgery, sex, history of smoking, a preexisting solitary kidney and symptomatic disease at presentation. Pathological features included histological subtype, nuclear grade, tumor stage (2003 TNM) and tumor size. Cancer specific survival was estimated using the Kaplan-Meier method.Results: A greater proportion of patients treated with NSS had a solitary kidney compared with patients treated ...