Download PDF
Semin intervent Radiol 2014; 31(01): 104-106
DOI: 10.1055/s-0033-1363851
Clinical Corner
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Nephron-Sparing Surgery

Paul Maroni
1   Division of Urology, School of Medicine, University of Colorado, Aurora, Colorado
,
Jacob Moss
1   Division of Urology, School of Medicine, University of Colorado, Aurora, Colorado
› Author Affiliations
Further Information

Publication History

Publication Date:
20 February 2014 (online)

Also available at
    Permissions and Reprints
Conclusion

The interventional radiologist should understand NSS and the current state of the art in the management of clinical stage 1 renal masses. As outlined in most clinical guidelines, NSS is the treatment of choice for the SRM in a healthy patient. Patient selection and preoperative preparation are critical for successful outcomes with NSS. RMB has a role, but has a nondiagnostic rate of around 10% as well as a NPV of only 75%, which cannot eliminate follow-up. Observation and ablation are reasonable treatment alternatives in the well-counseled patient.

 

  • References

  • 1 Lipworth L, Tarone RE, McLaughlin JK. The epidemiology of renal cell carcinoma. J Urol 2006; 176 (6 Pt 1): 2353-2358
    CrossrefPubMedGoogle Scholar
  • 2 Jemal A, Siegel R, Ward E , et al. Cancer statistics, 2008. CA Cancer J Clin 2008; 58 (2) 71-96
    CrossrefPubMedGoogle Scholar
  • 3 Campbell SC, Novick AC, Belldegrun A , et al; Practice Guidelines Committee of the American Urological Association. Guideline for management of the clinical T1 renal mass. J Urol 2009; 182 (4) 1271-1279
    CrossrefPubMedGoogle Scholar
  • 4 NCCN Clinical Guidelines in Oncology: Kidney Cancer v. 1. 2014. Available at: www.NCCN.org . Accessed January 8, 2014
    PubMedGoogle Scholar
  • 5 Frank I, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H. Solid renal tumors: an analysis of pathological features related to tumor size. J Urol 2003; 170 (6 Pt 1): 2217-2220
    CrossrefPubMedGoogle Scholar
  • 6 Kunkle DA, Crispen PL, Chen DYT, Greenberg RE, Uzzo RG. Enhancing renal masses with zero net growth during active surveillance. J Urol 2007; 177 (3) 849-853 , discussion 853–854
    CrossrefPubMedGoogle Scholar
  • 7 Lane BR, Novick AC. Nephron-sparing surgery. BJU Int 2007; 99 (5 Pt B, 5b): 1245-1250
    CrossrefPubMedGoogle Scholar
  • 8 Bijol V, Mendez GP, Hurwitz S, Rennke HG, Nosé V. Evaluation of the nonneoplastic pathology in tumor nephrectomy specimens: predicting the risk of progressive renal failure. Am J Surg Pathol 2006; 30 (5) 575-584
    CrossrefPubMedGoogle Scholar
  • 9 Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004; 351 (13) 1296-1305
    CrossrefPubMedGoogle Scholar
  • 10 Van Poppel H, Da Pozzo L, Albrecht W , et al. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol 2011; 59 (4) 543-552
    CrossrefPubMedGoogle Scholar
  • 11 RENAL Nephrometry Scoring System. Available at: www.nephrometry.com . Accessed October, 2013
    PubMedGoogle Scholar
  • 12 Ficarra V, Novara G, Secco S , et al. Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol 2009; 56 (5) 786-793
    CrossrefPubMedGoogle Scholar
  • 13 Hew MN, Baseskioglu B, Barwari K , et al. Critical appraisal of the PADUA classification and assessment of the R.E.N.A.L. nephrometry score in patients undergoing partial nephrectomy. J Urol 2011; 186 (1) 42-46
    CrossrefPubMedGoogle Scholar
  • 14 Kobayashi K, Saito T, Kitamura Y , et al. The RENAL Nephrometry Score and the PADUA Classification for the prediction of perioperative outcomes in patients receiving nephron-sparing surgery: feasible tools to predict intraoperative conversion to nephrectomy. Urol Int 2013; 91 (3) 261-268
    CrossrefPubMedGoogle Scholar
  • 15 Mir MC, Campbell RA, Sharma N , et al. Parenchymal volume preservation and ischemia during partial nephrectomy: functional and volumetric analysis. Urology 2013; 82 (2) 263-268
    CrossrefPubMedGoogle Scholar
  • 16 Gorin MA, Mullins JK, Pierorazio PM, Jayram G, Allaf ME. Increased intra-abdominal fat predicts perioperative complications following minimally invasive partial nephrectomy. Urology 2013; 81 (6) 1225-1230
    CrossrefPubMedGoogle Scholar
  • 17 Huang WC, Pinheiro LC, Russo P , et al. Surveillance for the management of small renal masses: utilization and outcomes in a population-based cohort. J Clin Oncol 2013; 31 (suppl 6; Abstr 343)
    PubMedGoogle Scholar
  • 18 Phé V, Yates DR, Renard-Penna R, Cussenot O, Rouprêt M. Is there a contemporary role for percutaneous needle biopsy in the era of small renal masses?. BJU Int 2012; 109 (6) 867-872
    CrossrefPubMedGoogle Scholar
  • 19 Gill IS, Patil MB, Abreu AL , et al. Zero ischemia anatomical partial nephrectomy: a novel approach. J Urol 2012; 187 (3) 807-814
    CrossrefPubMedGoogle Scholar
  • 20 Meng MV, Freise CE, Stoller ML. Laparoscopic nephrectomy, ex vivo excision and autotransplantation for complex renal tumors. J Urol 2004; 172 (2) 461-464
    CrossrefPubMedGoogle Scholar
  • 21 Fergany AF, Hafez KS, Novick AC. Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10-year followup. J Urol 2000; 163 (2) 442-445
    CrossrefPubMedGoogle Scholar
  • 22 Herr HW. Partial nephrectomy for unilateral renal carcinoma and a normal contralateral kidney: 10-year follow-up. J Urol 1999; 161 (1) 33-34 , discussion 34–35
    CrossrefPubMedGoogle Scholar
  • 23 Gill IS, Colombo Jr JR, Frank I , et al. Laparscopic partial nephrectomy for hilar tumors: a multi-institutional analysis. J Urol 2005; 174 (3) 850-853
    CrossrefPubMedGoogle Scholar
  • 24 Rogers CG, Metwalli A, Blatt AM , et al. Robotic partial nephrectomy for renal hilar tumors: a multi-institutional analysis. J Urol 2008; 180 (6) 2353-2356 , discussion 2356
    CrossrefPubMedGoogle Scholar
  • 25 Spana G, Haber GP, Dulabon LM , et al. Complications after robotic partial nephrectomy at centers of excellence: multi-institutional analysis of 450 cases. J Urol 2011; 186 (2) 417-421
    CrossrefPubMedGoogle Scholar
  • 26 Gill IS, Kavoussi LR, Lane BR , et al. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 2007; 178 (1) 41-46
    CrossrefPubMedGoogle Scholar