Nephron-Sparing Surgery for Renal Tumors Measuring More Than 7 cm: Morbidity, and Functional and Oncological Outcomes

Abstract Background The purpose of this study was to evaluate morbidity, functional, and oncological outcomes after NSS in renal tumors > 7 cm. Materials and Methods We retrospectively analyzed data from 168 patients with tumors > 7 cm who were treated using NSS between 1998 and 2012. Results Imperative and elective indications accounted for 76 (45.2%) and 92 (54.8%) patients, respectively. Major perioperative complications and renal function deterioration occurred in 33 (19.6%) and 51 patients (30.4%), respectively. In multivariate analysis, age older than 60 years ( P  = .001; hazard ratio [HR], 5) and tumor malignancy ( P  = .014; HR, 6.7) were prognostic factors for renal function deterioration whereas imperative indication was a risk factor for major postoperative complications ( P  = .0019; HR, 2.7). In 126 (75%) patients with malignant tumors, after a median follow-up of 30 months (range, 1-254 months), 25 patients (20.2%) died. In multivariate analysis, imperative indication ( P  = .023; HR, 4.2), positive surgical margin ( P  = .021; HR, 3.3), and Fuhrman grade > II ( P  = .013; HR, 3.7) were prognostic indicators for cancer-free survival (CFS). Imperative indication ( P  = .04; HR, 8.5) and Fuhrman grade > II ( P  = .04; HR, 3.9) were predictive factors of cancer-specific survival (CSS). In case of elective indication, positive surgical margin, local recurrence, and cancer-related death occurred in 4 (7.6%), 1 (1.1%), and 1 (1.1%) cases, respectively. For elective indication, 5-year estimates of CFS, CSS, and overall survival rates were: 85.7%, 98%, and 93.9%, respectively. Conclusion In this selected population, imperative vs. elective indication status seems to play a critical role in oncologic outcomes. Oncologic results for elective indications are close to those reported with radical nephrectomy.