Tumour size, tumour complexity, and surgical approach are associated with nephrectomy type in small renal cortical tumours treated electively

摘要

OBJECTIVE To identify preoperative variables associated with choice of partial nephrectomy (PN) vs radical nephrectomy (RN). PATIENTS AND METHODS Between January 2004 and June 2008, 203 patients were treated for clinical T1a renal cortical tumours. Of these, 154 (75.8%) had all data available and form the analytic cohort. Patients were categorized into two groups, PN and RN, based on preoperative treatment plan. Patient-, procedure-, and tumour-related variables, together with tumour complexity (based on the R.E.N.A.L Nephrometry Score [RENAL-NS]) were evaluated for their association with planned PN vs RN. RESULTS PN was planned in 120/154 patients (77.9%). Minimally invasive surgical approaches were planned in 66/154 cases overall (42.9%) and in 40/120 PN cases (33.3%). On univariate analysis, lower American Society of Anesthesiologists (ASA) score, planned open approach, smaller tumour size, left-sided tumour, and lower RENAL-NS were associated with planned PN. On multivariate analysis three factors remained independently associated with PN: tumour size (each 1 cm decrease in tumour size odds ratio [OR] 2.2, 95% confidence interval [CI] 1.2-4.0, P= 0.011), tumour complexity quantified by RENAL-NS (each 1 point decrease OR 2.4, 95% CI 1.5-3.7, P < 0.001), and planned open surgical approach (OR 7.3, 95% CI 2.2-25, P= 0.001). CONCLUSIONS The decision to perform elective PN is based primarily on tumour anatomical features but is also associated with surgical approach. The RENAL-NS accurately predicts nephrectomy type in clinical T1a renal cortical tumours.