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Mini-Margin Nephron Sparing Surgery for Renal Cell Carcinoma 4?cm or Less

DOI: 10.1155/2010/145942

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Objectives. To explore the safety and efficacy of mini-margin nephron sparing surgery (NSS) for renal cell carcinoma (RCC) 4?cm or less. Methods. Total of 389 cases of RCC 4?cm or less with normal contralateral kidneys were included in the study, including 135 cases treated by mini-margin NSS, 98 by 1?cm-NSS and 156 by radical nephrectomy (RN). The clinical results were followed-up and comparatively analyzed. Results. The mean and median margin width for mm-NSS was 2.2 and 2.0?mm (range 0 to 5). Of them, 112 (83.0%) cases had margins of 3?mm or less, and 26 had margins of 0?mm (19.3%). The mean width of margin for 1?cm-NSS was 11.6?mm (median 12, range 10 15). None of the NSS patients had positive surgical margins. The mean follow-up for mm-NSS, 1?cm-NSS and RN patients was 69, 82 and 82 months, respectively. Three mm-NSS patients, two 1?cm- NSS and four RN patients died of non-cancer related causes. Two mm-NSS patient (1.6%) experienced local recurrence. No distant metastasis was detected in all the patients. The over all 5-year survivals for NSS and RN patients were 100%, 100% and 98.7%, respectively ( ). Conclusions. Mini-margin NSS is as safe and effective as 1?cm-NSS and RN in treating early localized RCC 4?cm or less. 1. Introduction Nephron sparing surgery (NSS) has proven to be a safe and effective approach for renal cell carcinoma (RCC), with comparable clinical results to radical nephrectomy, especially for the tumors 4?cm or less, even in patients with completely normal opposite kidneys. For many years, surgical practice for NSS was to have a more than 1?cm margin of normal tissue around the tumor [1, 2]. However, more recent studies show that the width of the margin seems not important. NSS with a smaller margin is as well safe and effective in tumor control [3]. And even pure enucleation is as effective as partial nephrectomy with a rim of healthy parenchyma [4]. From January 1998 to December 2008, based on the previous studies in our institute, 135 cases of RCC 4?cm or less in diameter and staged as T1aN0M0 with normal contralateral kidney were treated with 5?mm mini-margin NSS (mm-NSS). The clinical results were followed and compared with 99 cases of NSS with margin 1?cm or more (1?cm-NSS) and 156 cases of radical nephrectomy (RN) for RCC of same stage. The Data were comparatively analyzed to evaluate the safety and efficacy of mini-margin NSS in treating early localized RCC 4?cm or less. 2. Materials And Methods 2.1. Patient Selection Only patients with RCC 4?cm or less, with normal contralateral kidney, without lymph node or distant

References

[1]  A. C. Novick and S. B. Streem, “Surgery of the kidney,” in Campbell’s Urology, P. C. Walsh, A. B. Retik, E. D. Vaughan, and A. J. Wein, Eds., pp. 2973–3061, WB Saunders, Philadelphia, Pa, USA, 7th edition, 1998.
[2]  A. Zucchi, L. Mearini, E. Mearini, E. Costantini, C. Vivacqua, and M. Porena, “Renal cell carcinoma: histological findings on surgical margins after nephron sparing surgery,” Journal of Urology, vol. 169, no. 3, pp. 905–908, 2003.
[3]  Z. Ak?etin, V. Zugor, D. Els?sser, F. S. Krause, B. Lausen, K. M. Schrott, and D. G. Engehausen, “Does the distance to normal renal parenchyma (DTNRP) in nephron-sparing surgery for renal cell carcinoma have an effect on survival?” Anticancer Research, vol. 25, no. 3A, pp. 1629–1632, 2005.
[4]  M. Carini, A. Minervini, L. Masieri, A. Lapini, and S. Serni, “Simple enucleation for the treatment of PT1a renal cell carcinoma: our 20-year experience,” European Urology, vol. 50, no. 6, pp. 1263–1271, 2006.
[5]  Q.-L. Li, L. Cheng, H.-W. Guan, Y. Zhang, F.-P. Wang, and X.-S. Song, “Safety and efficacy of mini-margin nephron-sparing surgery for renal cell carcinoma 4-cm or less,” Urology, vol. 71, no. 5, pp. 924–927, 2008.
[6]  R. G. Uzzo and A. C. Novick, “Nephron sparing surgery for renal tumors: indications, techniques and outcomes,” Journal of Urology, vol. 166, no. 1, pp. 6–18, 2001.
[7]  F. Becker, S. Siemer, U. Humke, M. Hack, M. Ziegler, and M. St?ckle, “Elective nephron sparing surgery should become standard treatment for small unilateral renal cell carcinoma: long-term survival data of 216 patients,” European Urology, vol. 49, no. 2, pp. 308–313, 2006.
[8]  S. Pahernik, F. Roos, C. Hampel, R. Gillitzer, S. W. Melchior, and J. W. Thüroff, “Nephron sparing surgery for renal cell carcinoma with normal contralateral kidney: 25 years of experience,” Journal of Urology, vol. 175, no. 6, pp. 2027–2031, 2006.
[9]  W. K. O. Lau, M. L. Blute, A. L. Weaver, V. E. Torres, and H. Zincke, “Matched comparison of radical nephrectomy vs nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney,” Mayo Clinic Proceedings, vol. 75, no. 12, pp. 1236–1242, 2000.
[10]  C. T. Lee, J. Katz, W. Shi, H. T. Thaler, V. E. Reuter, and P. Russo, “Surgical management of renal tumors 4?cm or less in a contemporary cohort,” Journal of Urology, vol. 163, no. 3, pp. 730–736, 2000.
[11]  J. M. Corman, D. F. Penson, K. Hur, S. F. Khuri, J. Daley, W. Henderson, and J. N. Krieger, “Comparison of complications after radical and partial nephrectomy: results from the National Veterans Administration Surgical Quality Improvement Program,” BJU International, vol. 86, no. 7, pp. 782–789, 2000.
[12]  B. Shekarriz, J. Upadhyay, and J. Upadhyay, “Comparison of costs and complications of radical and partial nephrectomy for treatment of localized renal cell carcinoma,” Urology, vol. 59, no. 2, pp. 211–215, 2002.
[13]  E. A. Castilla, L. S. Liou, N. A. Abrahams, A. Fergany, L. A. Rybicki, J. Myles, and A. C. Novick, “Prognostic importance of resection margin width after nephron-sparing surgery for renal cell carcinoma,” Urology, vol. 60, no. 6, pp. 993–997, 2002.
[14]  N. Y. Piper, J. T. Bishoff, and J. T. Bishoff, “Is a 1-cm margin necessary during nephron-sparing surgery for renal cell carcinoma?” Urology, vol. 58, no. 6, pp. 849–852, 2001.
[15]  S. E. Sutherland, M. I. Resnick, G. T. Maclennan, and H. B. Goldman, “Does the size of the surgical margin in partial nephrectomy for renal cell cancer really matter?” Journal of Urology, vol. 167, no. 1, pp. 61–64, 2002.
[16]  M.-O. Timsit, J.-P. Bazin, N. Thiounn, E. Fontaine, Y. Chrétien, B. Dufour, and A. Méjean, “Prospective study of safety margins in partial nephrectomy: intraoperative assessment and contribution of frozen section analysis,” Urology, vol. 67, no. 5, pp. 923–926, 2006.
[17]  N. Berdjis, O. W. Hakenberg, S. Zastrow, S. Oehlschl?ger, V. Novotny, and M. P. Wirth, “Impact of resection margin status after nephron-sparing surgery for renal cell carcinoma,” BJU International, vol. 97, no. 6, pp. 1208–1210, 2006.
[18]  Q.-L. Li, H.-W. Guan, Q.-P. Zhang, L.-Z. Zhang, F.-P. Wang, and Y.-J. Liu, “Optimal margin in nephron-sparing surgery for renal cell carcinoma 4?cm or less,” European Urology, vol. 44, no. 4, pp. 448–451, 2003.

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