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Partial versus Total Nephrectomy in the Treatment of Renal Cell Carcinoma

Amelia Davies (St Hugh’s College) and Edmund Watson (Brasenose College). Partial versus Total Nephrectomy in the Treatment of Renal Cell Carcinoma. The Question. AM is a 53 year old woman in whom a 5 cm mass has recently been found in the upper pole of the left kidney.

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Partial versus Total Nephrectomy in the Treatment of Renal Cell Carcinoma

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  1. Amelia Davies (St Hugh’s College) and Edmund Watson (Brasenose College) Partial versus Total Nephrectomy in the Treatment of Renal Cell Carcinoma

  2. The Question • AM is a 53 year old woman in whom a 5 cm mass has recently been found in the upper pole of the left kidney. • The mass appears to be discrete upon imaging, and surgery is the best option. • However, should the surgeon undertake a partial or a radical (total) nephrectomy? Does the safety margin of a total resection even exist, and if so, is it negated by the loss of a whole kidney?

  3. Advanced Searches on PubMed and Scopus. We used the search terms: Total 159 hits, of which many duplicates; Weight et al was the only study to feature in the top ten of both searches, and appeared to be of good quality. Weight et al.“Elective Partial Nephrectomy in Patients With Clinical T1b Renal Tumors Is Associated With Improved Overall Survival.” Urology76:631–638, 2010. The Search

  4. Study Appraisal • Strengths • Cohort of 510 subjects recruited • RN=298 • PN=212 • Age range of subjects was 48-71 years • All subjects had a normal contralateral kidney and GFR at the time of surgery as well as no evidence of metastasis; in all cases, tumours were believed to be sporadic. • Weaknesses • Patients were not randomised into PN and RN groups. • To minimise bias authors compared cancer specific survival stage-by-stage and grade-by-grade • Used statistical techniques to account for differing prognoses. • Adjunctive therapy was not addressed. • Follow-up time was five years.

  5. THE RESULTS • Cancer-specific survival was similar between cohorts when compared by pathologic stage and grade • RN=87.9% ±4.6 • PN=97.8% ±2.5 • PN was associated with better overall survival • RN=82.4% ±5.1 • PN=94.2% ±2.5 • Post-operative GFR is a good indicator of non-cancer specific survival • The drop in GFR was significantly less in the PN group (PN=18%, RN=31%).

  6. The results of this study suggest that AM would likely benefit from partial over radical nephrectomy. • This is indicated because: • the mass is discrete according to radiology • it is of a relatively small size • Were the tumour of a higher grade, we could not safely conclude that PN is preferable to RN. The implications

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