Collaborative Review of Risk Benefit Trade-offs Between Partial and Radical Nephrectomy in the Management of Anatomically Complex Renal Masses

Collaborative Review of Risk Benefit Trade-offs Between Partial and Radical Nephrectomy in the Management of Anatomically Complex Renal Masses

Abstract Background While partial nephrectomy (PN) is the recommended treatment for many small renal masses, anatomically complex tumors necessitate a clear understanding of the potential risks and benefits of PN and radical nephrectomy (RN). Objective To critically review the comparative effectiven...

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Published in:European urology Vol. 72; no. 1; pp. 64 - 75
Main Authors: Kim, Simon P, Campbell, Steven C, Gill, Inderbir, Lane, Brian R, Van Poppel, Hein, Smaldone, Marc C, Volpe, Alessandro, Kutikov, Alexander
Format: Journal Article
Language:English
Published: Switzerland Elsevier B.V 01-07-2017
Subjects:
Clinical Decision-Making
Humans
Kidney Neoplasms - diagnostic imaging
Kidney Neoplasms - mortality
Kidney Neoplasms - pathology
Kidney Neoplasms - surgery
Nephrectomy - adverse effects
Nephrectomy - methods
Nephrectomy - mortality
Partial nephrectomy
Patient Selection
Radical nephrectomy
Renal cell carcinoma
Renal masses
Risk Assessment
Risk Factors
Surgery
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Tumor Burden
Urology
Radical nephrectomy
Partial nephrectomy
Renal cell carcinoma
Renal masses
Surgery
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Abstract Abstract Background While partial nephrectomy (PN) is the recommended treatment for many small renal masses, anatomically complex tumors necessitate a clear understanding of the potential risks and benefits of PN and radical nephrectomy (RN). Objective To critically review the comparative effectiveness evidence of PN versus RN; to describe key trade-offs involved in this treatment decision; and to highlight gaps in the current literature. Evidence acquisition A collaborative critical review of the medical literature was conducted. Evidence synthesis Patients who undergo PN for an anatomically complex or large mass may be exposed to perioperative and potential oncologic risks that could be avoided if RN were performed, while patients who undergo RN may forgo long-term benefits of renal preservation. Decision-making regarding the optimal treatment with PN or RN among patients with anatomically complex or large renal mass is highly nuanced and must balance the risks and benefits of each approach. Currently, high-quality evidence on comparative effectiveness is sparse. Retrospective comparisons are plagued by selection biases, while the one existing prospective randomized trial, albeit imperfect, suggests that nephron-sparing surgery may not benefit all patients. Conclusions For anatomically complex tumors, PN preserves renal parenchyma but may expose patients to higher perioperative risks than RN. The risks and benefits of each surgical approach must be better objectified for identification of patients most suitable for complex PN. A prospective randomized trial is warranted and would help in directing patient counseling. Patient summary Treatment decisions for complex renal masses require shared decision-making regarding the risk trade-offs between partial and radical nephrectomy.
AbstractList BACKGROUNDWhile partial nephrectomy (PN) is the recommended treatment for many small renal masses, anatomically complex tumors necessitate a clear understanding of the potential risks and benefits of PN and radical nephrectomy (RN).OBJECTIVETo critically review the comparative effectiveness evidence of PN versus RN; to describe key trade-offs involved in this treatment decision; and to highlight gaps in the current literature.EVIDENCE ACQUISITIONA collaborative critical review of the medical literature was conducted.EVIDENCE SYNTHESISPatients who undergo PN for an anatomically complex or large mass may be exposed to perioperative and potential oncologic risks that could be avoided if RN were performed, while patients who undergo RN may forgo long-term benefits of renal preservation. Decision-making regarding the optimal treatment with PN or RN among patients with anatomically complex or large renal mass is highly nuanced and must balance the risks and benefits of each approach. Currently, high-quality evidence on comparative effectiveness is sparse. Retrospective comparisons are plagued by selection biases, while the one existing prospective randomized trial, albeit imperfect, suggests that nephron-sparing surgery may not benefit all patients.CONCLUSIONSFor anatomically complex tumors, PN preserves renal parenchyma but may expose patients to higher perioperative risks than RN. The risks and benefits of each surgical approach must be better objectified for identification of patients most suitable for complex PN. A prospective randomized trial is warranted and would help in directing patient counseling.PATIENT SUMMARYTreatment decisions for complex renal masses require shared decision-making regarding the risk trade-offs between partial and radical nephrectomy.
While partial nephrectomy (PN) is the recommended treatment for many small renal masses, anatomically complex tumors necessitate a clear understanding of the potential risks and benefits of PN and radical nephrectomy (RN). To critically review the comparative effectiveness evidence of PN versus RN; to describe key trade-offs involved in this treatment decision; and to highlight gaps in the current literature. A collaborative critical review of the medical literature was conducted. Patients who undergo PN for an anatomically complex or large mass may be exposed to perioperative and potential oncologic risks that could be avoided if RN were performed, while patients who undergo RN may forgo long-term benefits of renal preservation. Decision-making regarding the optimal treatment with PN or RN among patients with anatomically complex or large renal mass is highly nuanced and must balance the risks and benefits of each approach. Currently, high-quality evidence on comparative effectiveness is sparse. Retrospective comparisons are plagued by selection biases, while the one existing prospective randomized trial, albeit imperfect, suggests that nephron-sparing surgery may not benefit all patients. For anatomically complex tumors, PN preserves renal parenchyma but may expose patients to higher perioperative risks than RN. The risks and benefits of each surgical approach must be better objectified for identification of patients most suitable for complex PN. A prospective randomized trial is warranted and would help in directing patient counseling. Treatment decisions for complex renal masses require shared decision-making regarding the risk trade-offs between partial and radical nephrectomy. Patients presenting with complex renal tumors that are larger, centrally located, or endophytic should have a balanced discussion about the benefits and potential risks of partial versus radical nephrectomy. Although partial nephrectomy confers improved renal function and possibly superior overall survival compared to radical nephrectomy, this treatment may be associated with higher perioperative risks and has oncologic considerations that require detailed patient counseling and considerable surgical expertise.
Abstract Background While partial nephrectomy (PN) is the recommended treatment for many small renal masses, anatomically complex tumors necessitate a clear understanding of the potential risks and benefits of PN and radical nephrectomy (RN). Objective To critically review the comparative effectiveness evidence of PN versus RN; to describe key trade-offs involved in this treatment decision; and to highlight gaps in the current literature. Evidence acquisition A collaborative critical review of the medical literature was conducted. Evidence synthesis Patients who undergo PN for an anatomically complex or large mass may be exposed to perioperative and potential oncologic risks that could be avoided if RN were performed, while patients who undergo RN may forgo long-term benefits of renal preservation. Decision-making regarding the optimal treatment with PN or RN among patients with anatomically complex or large renal mass is highly nuanced and must balance the risks and benefits of each approach. Currently, high-quality evidence on comparative effectiveness is sparse. Retrospective comparisons are plagued by selection biases, while the one existing prospective randomized trial, albeit imperfect, suggests that nephron-sparing surgery may not benefit all patients. Conclusions For anatomically complex tumors, PN preserves renal parenchyma but may expose patients to higher perioperative risks than RN. The risks and benefits of each surgical approach must be better objectified for identification of patients most suitable for complex PN. A prospective randomized trial is warranted and would help in directing patient counseling. Patient summary Treatment decisions for complex renal masses require shared decision-making regarding the risk trade-offs between partial and radical nephrectomy.
While partial nephrectomy (PN) is the recommended treatment for many small renal masses, anatomically complex tumors necessitate a clear understanding of the potential risks and benefits of PN and radical nephrectomy (RN). To critically review the comparative effectiveness evidence of PN versus RN; to describe key trade-offs involved in this treatment decision; and to highlight gaps in the current literature. A collaborative critical review of the medical literature was conducted. Patients who undergo PN for an anatomically complex or large mass may be exposed to perioperative and potential oncologic risks that could be avoided if RN were performed, while patients who undergo RN may forgo long-term benefits of renal preservation. Decision-making regarding the optimal treatment with PN or RN among patients with anatomically complex or large renal mass is highly nuanced and must balance the risks and benefits of each approach. Currently, high-quality evidence on comparative effectiveness is sparse. Retrospective comparisons are plagued by selection biases, while the one existing prospective randomized trial, albeit imperfect, suggests that nephron-sparing surgery may not benefit all patients. For anatomically complex tumors, PN preserves renal parenchyma but may expose patients to higher perioperative risks than RN. The risks and benefits of each surgical approach must be better objectified for identification of patients most suitable for complex PN. A prospective randomized trial is warranted and would help in directing patient counseling. Treatment decisions for complex renal masses require shared decision-making regarding the risk trade-offs between partial and radical nephrectomy.
Author Campbell, Steven C
Gill, Inderbir
Kutikov, Alexander
Smaldone, Marc C
Van Poppel, Hein
Lane, Brian R
Volpe, Alessandro
Kim, Simon P
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/27988238$$D View this record in MEDLINE/PubMed
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Keywords Radical nephrectomy
Partial nephrectomy
Renal cell carcinoma
Renal masses
Surgery
Language English
License Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.
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Snippet Abstract Background While partial nephrectomy (PN) is the recommended treatment for many small renal masses, anatomically complex tumors necessitate a clear...
While partial nephrectomy (PN) is the recommended treatment for many small renal masses, anatomically complex tumors necessitate a clear understanding of the...
BACKGROUNDWhile partial nephrectomy (PN) is the recommended treatment for many small renal masses, anatomically complex tumors necessitate a clear...
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SubjectTerms Clinical Decision-Making
Humans
Kidney Neoplasms - diagnostic imaging
Kidney Neoplasms - mortality
Kidney Neoplasms - pathology
Kidney Neoplasms - surgery
Nephrectomy - adverse effects
Nephrectomy - methods
Nephrectomy - mortality
Partial nephrectomy
Patient Selection
Radical nephrectomy
Renal cell carcinoma
Renal masses
Risk Assessment
Risk Factors
Surgery
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Tumor Burden
Urology
Title Collaborative Review of Risk Benefit Trade-offs Between Partial and Radical Nephrectomy in the Management of Anatomically Complex Renal Masses
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https://dx.doi.org/10.1016/j.eururo.2016.11.038
https://www.ncbi.nlm.nih.gov/pubmed/27988238
https://search.proquest.com/docview/1851286804
Volume 72
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