Partial nephrectomy for selected renal cortical tumours of ≥7 cm

Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE To examine our institutional experience in patients treated with partial nephrectomy (PN) for renal cortical tumours (RCTs) of ≥7 cm, as PN is an accepted surgical approach for appropriate RCTs of <7 cm but there are limited data on the use of PN for larger tumours. PATIENTS AND METHODS After Institutional Review Board approval, we examined our prospectively collected surgical database for patients treated with PN for RCTs of ≥7 cm between 1989 and 2008. Pertinent demographic, clinical, surgical and pathological data were reviewed. RESULTS In all, 34 patients (37 renal units) were identified for analysis with a median (interquartile range, IQR) age of 63 (52–71) years, median (IQR) tumour size of 7.5 (7.2–9.0) cm with the largest tumour being 19 cm. In 31 renal units (28 patients, 84%) carcinoma was evident, with 16 renal units (43%) having conventional clear cell carcinoma, followed by papillary in eight renal units (21%). Currently, 20 of these 28 patients (71%) are disease free, three are alive with metastatic disease (two had known preoperative metastatic disease), three died from disease and two died from other causes. The median (IQR) preoperative estimated glomerular filtration rate was 65 (55–73) mL/min/1.73 m2, compared with 55 (47–74) mL/min/1.73 m2 after PN (P= 0.003, paired Student’s t-test). CONCLUSIONS Our findings suggest that PN for RCTs of ≥7 cm can be safely performed and provide effective tumour control for selected patients. PN should be considered for patients with appropriate tumours, solitary kidneys or pre-existing renal insufficiency.