Laparoscopic radical nephrectomy for large renal masses: Critical assessment of perioperative and oncologic outcomes of stage T2a and T2b tumors

Phillip Martin Pierorazio, Elias S. Hyams, Brian M. Lin, Jeffrey K. Mullins, Mohamad E Allaf

Research output: Contribution to journalArticle

Abstract

Objective: To analyze the perioperative and oncologic outcomes of >7 cm renal tumors treated with laparoscopic radical nephrectomy (LRN) at a high-volume academic center. The indications for LRN have expanded to include larger (>7 cm) lesions. Methods: The Institutional Minimally Invasive Urologic Surgery Database (1994 to the present) was reviewed for patients undergoing LRN for >7-cm masses (American Joint Committee on Cancer clinical Stage T2N0M0). Results: Of 200 patients, 138 (69.0%) had tumors >7.0-10 cm and 62 (31.0%) had tumors >10 cm. The patients with tumors >10 cm presented more often with symptoms, most often hematuria, and more often had high-grade tumors (68% vs 44%, P =.005). Also, a greater proportion were papillary renal cell carcinoma (23% vs 14%, P =.09) and were more often upstaged (21% vs 9%, P =.02). Of the 200 tumors, 74 (37%) were upstaged, 58 (29%) with perinephric extension and 26 (13%) with renal vein invasion. Larger tumors had greater blood loss on average (406 vs 288 mL, respectively, P =.1) and were converted to open surgery more often (13.8% vs 2.1%, P =.001). A total of 47 patients (22.3%) experienced a postoperative complication. The 5-year recurrence-free survival and cancer-specific survival rate was 62.4% and 92.9%, respectively. The significant predictors of recurrence-free survival in the multivariate model were clear cell histologic type, high Fuhrman grade, renal vein invasion, and perinephric extension. Of note, pT2b was not a predictor of recurrence. Conclusion: LRN can have favorable perioperative and oncologic outcomes for large (>7 cm) renal masses, with an open conversion rate and complication rate of 5% and 20%, respectively. Clear cell histologic features, high-grade tumors, renal vein invasion, and perinephric extension, but not tumor size, were poor prognostic indicators in this cohort.

Original languageEnglish (US)
Pages (from-to)570-575
Number of pages6
JournalUrology
Volume79
Issue number3
DOIs
StatePublished - Mar 2012

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Nephrectomy
Kidney
Neoplasms
Renal Veins
Recurrence
Minimally Invasive Surgical Procedures
Survival
Hematuria
Renal Cell Carcinoma
Survival Rate
Databases

ASJC Scopus subject areas

  • Urology

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Laparoscopic radical nephrectomy for large renal masses : Critical assessment of perioperative and oncologic outcomes of stage T2a and T2b tumors. / Pierorazio, Phillip Martin; Hyams, Elias S.; Lin, Brian M.; Mullins, Jeffrey K.; Allaf, Mohamad E.

In: Urology, Vol. 79, No. 3, 03.2012, p. 570-575.

Research output: Contribution to journalArticle

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title = "Laparoscopic radical nephrectomy for large renal masses: Critical assessment of perioperative and oncologic outcomes of stage T2a and T2b tumors",
abstract = "Objective: To analyze the perioperative and oncologic outcomes of >7 cm renal tumors treated with laparoscopic radical nephrectomy (LRN) at a high-volume academic center. The indications for LRN have expanded to include larger (>7 cm) lesions. Methods: The Institutional Minimally Invasive Urologic Surgery Database (1994 to the present) was reviewed for patients undergoing LRN for >7-cm masses (American Joint Committee on Cancer clinical Stage T2N0M0). Results: Of 200 patients, 138 (69.0{\%}) had tumors >7.0-10 cm and 62 (31.0{\%}) had tumors >10 cm. The patients with tumors >10 cm presented more often with symptoms, most often hematuria, and more often had high-grade tumors (68{\%} vs 44{\%}, P =.005). Also, a greater proportion were papillary renal cell carcinoma (23{\%} vs 14{\%}, P =.09) and were more often upstaged (21{\%} vs 9{\%}, P =.02). Of the 200 tumors, 74 (37{\%}) were upstaged, 58 (29{\%}) with perinephric extension and 26 (13{\%}) with renal vein invasion. Larger tumors had greater blood loss on average (406 vs 288 mL, respectively, P =.1) and were converted to open surgery more often (13.8{\%} vs 2.1{\%}, P =.001). A total of 47 patients (22.3{\%}) experienced a postoperative complication. The 5-year recurrence-free survival and cancer-specific survival rate was 62.4{\%} and 92.9{\%}, respectively. The significant predictors of recurrence-free survival in the multivariate model were clear cell histologic type, high Fuhrman grade, renal vein invasion, and perinephric extension. Of note, pT2b was not a predictor of recurrence. Conclusion: LRN can have favorable perioperative and oncologic outcomes for large (>7 cm) renal masses, with an open conversion rate and complication rate of 5{\%} and 20{\%}, respectively. Clear cell histologic features, high-grade tumors, renal vein invasion, and perinephric extension, but not tumor size, were poor prognostic indicators in this cohort.",
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T2 - Critical assessment of perioperative and oncologic outcomes of stage T2a and T2b tumors

AU - Pierorazio, Phillip Martin

AU - Hyams, Elias S.

AU - Lin, Brian M.

AU - Mullins, Jeffrey K.

AU - Allaf, Mohamad E

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N2 - Objective: To analyze the perioperative and oncologic outcomes of >7 cm renal tumors treated with laparoscopic radical nephrectomy (LRN) at a high-volume academic center. The indications for LRN have expanded to include larger (>7 cm) lesions. Methods: The Institutional Minimally Invasive Urologic Surgery Database (1994 to the present) was reviewed for patients undergoing LRN for >7-cm masses (American Joint Committee on Cancer clinical Stage T2N0M0). Results: Of 200 patients, 138 (69.0%) had tumors >7.0-10 cm and 62 (31.0%) had tumors >10 cm. The patients with tumors >10 cm presented more often with symptoms, most often hematuria, and more often had high-grade tumors (68% vs 44%, P =.005). Also, a greater proportion were papillary renal cell carcinoma (23% vs 14%, P =.09) and were more often upstaged (21% vs 9%, P =.02). Of the 200 tumors, 74 (37%) were upstaged, 58 (29%) with perinephric extension and 26 (13%) with renal vein invasion. Larger tumors had greater blood loss on average (406 vs 288 mL, respectively, P =.1) and were converted to open surgery more often (13.8% vs 2.1%, P =.001). A total of 47 patients (22.3%) experienced a postoperative complication. The 5-year recurrence-free survival and cancer-specific survival rate was 62.4% and 92.9%, respectively. The significant predictors of recurrence-free survival in the multivariate model were clear cell histologic type, high Fuhrman grade, renal vein invasion, and perinephric extension. Of note, pT2b was not a predictor of recurrence. Conclusion: LRN can have favorable perioperative and oncologic outcomes for large (>7 cm) renal masses, with an open conversion rate and complication rate of 5% and 20%, respectively. Clear cell histologic features, high-grade tumors, renal vein invasion, and perinephric extension, but not tumor size, were poor prognostic indicators in this cohort.

AB - Objective: To analyze the perioperative and oncologic outcomes of >7 cm renal tumors treated with laparoscopic radical nephrectomy (LRN) at a high-volume academic center. The indications for LRN have expanded to include larger (>7 cm) lesions. Methods: The Institutional Minimally Invasive Urologic Surgery Database (1994 to the present) was reviewed for patients undergoing LRN for >7-cm masses (American Joint Committee on Cancer clinical Stage T2N0M0). Results: Of 200 patients, 138 (69.0%) had tumors >7.0-10 cm and 62 (31.0%) had tumors >10 cm. The patients with tumors >10 cm presented more often with symptoms, most often hematuria, and more often had high-grade tumors (68% vs 44%, P =.005). Also, a greater proportion were papillary renal cell carcinoma (23% vs 14%, P =.09) and were more often upstaged (21% vs 9%, P =.02). Of the 200 tumors, 74 (37%) were upstaged, 58 (29%) with perinephric extension and 26 (13%) with renal vein invasion. Larger tumors had greater blood loss on average (406 vs 288 mL, respectively, P =.1) and were converted to open surgery more often (13.8% vs 2.1%, P =.001). A total of 47 patients (22.3%) experienced a postoperative complication. The 5-year recurrence-free survival and cancer-specific survival rate was 62.4% and 92.9%, respectively. The significant predictors of recurrence-free survival in the multivariate model were clear cell histologic type, high Fuhrman grade, renal vein invasion, and perinephric extension. Of note, pT2b was not a predictor of recurrence. Conclusion: LRN can have favorable perioperative and oncologic outcomes for large (>7 cm) renal masses, with an open conversion rate and complication rate of 5% and 20%, respectively. Clear cell histologic features, high-grade tumors, renal vein invasion, and perinephric extension, but not tumor size, were poor prognostic indicators in this cohort.

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