%0 Journal Article
%T Nephron-Sparing Surgery for Renal Masses Measuring Larger Than on Preoperative Imaging: A Single Surgeon, Single Center Experience
%A Tar£¿k Esen
%A £¿mer Acar
%A Ahmet Musao£¿lu
%A Metin Vural
%A Sergin Akpek
%J ISRN Surgery
%D 2013
%R 10.1155/2013/691080
%X Objectives. To document the feasibility of nephron-sparing surgery (NSS) for the surgical treatment of renal masses measuring larger than 7£¿cm (cT2) on preoperative imaging. Methods. A total of 139 patients have undergone NSS between 2001 and 2012 by a single surgeon in our clinic. Of these, we identified 17 patients whose tumors were measuring greater than 7£¿cm on preoperative imaging studies and were limited to the kidney. Their charts were retrospectively reviewed. Results. Mean age of the study population was years. Thirteen patients were managed by open NSS, while 4 patients have undergone robot-assisted NSS. Mean diameter and mean R.E.N.A.L. score of the tumors that were enucleoresected were 8.2£¿cm and 8.5, respectively. A total of 5 Clavien grade 2 and higher complications were recorded within 30 days of surgery. Histopathologic examination revealed benign histology in almost 1/4 of the cases. After a median followup of 33 months, all of our patients were alive. Only one patient (5.8%) experienced local recurrence. Conclusions. NSS is a feasible and safe option for large (>7£¿cm) renal masses. It may be considered not only for imperative conditions but also for highly selected cases with a normal contralateral kidney. 1. Introduction Nephron-sparing surgery (NSS) offers equivalent oncologic control, as does radical nephrectomy in patients with appropriately selected stage T1 renal tumors [1, 2]. Additionally, NSS has been associated with decreased risks for renal impairment [3¨C5] and cardiovascular events [6, 7], which may explain the improved overall survival, documented in partial nephrectomy series [8]. Current guidelines emphasize NSS for all anatomically amenable T1 renal tumors [9]. As the benefits of NSS become apparent, the indications may continue to expand [10]. In order to establish standards for future comparisons, we must fully appreciate the efficacy, safety, and limitations of NSS for renal masses larger than 7£¿cm. Therefore, we reviewed our experience and reported the results in 17 patients with renal masses, which had a maximum diameter of more than 7£¿cm on preoperative imaging studies, treated with either open or robot-assisted laparoscopic NSS during 13 years. 2. Methods Between 2001 and 2012, a single surgeon (TE) performed 139 NSSs (97 open, 35 robot-assisted, and 7 laparoscopic NSSs) in one center. We retrospectively reviewed the charts of the patients, whose renal tumors measured more than 7£¿cm in diameter on preoperative imaging . Preoperative evaluation consisted of laboratory tests and cross-sectional imaging studies
%U http://www.hindawi.com/journals/isrn.surgery/2013/691080/