Open partial nephrectomy for renal cell cancer in a medium patient volume centre: Is high quality possible?

Abstract

Objective. To describe the surgical complication rate of open partial nephrectomy (OPN) in patients with renal tumours, and to report the oncological long-term outcome in unilateral renal cell cancer patients subjected to this procedure, from a medium patient volume urological centre. Material and methods. Data from all patients (n = 89) subjected to OPN for proven or suspected renal cell cancer during the period 1965–2007 were registered in a specifically designed database system. Tumour stage and size, surgical margin, histology, perioperative and postoperative complications were analysed in all patients. In addition, long-term follow-up outcomes in malignant unilateral tumours (n = 51) were analysed. Results. Seventy-four of the resected tumours were malignant. Six of these had a positive surgical margin; five from patients with multifocal or bilateral tumours and one from a patient with a solitary malignant cyst. Perioperative complications were registered in only one case (1%). Postoperative complications (within 30 days postoperatively) reached 18%. The long-term follow-up (mean 79 months, median 49 months, range 14 months to 26 years) in patients with unilateral malignant tumours, all staged T1–T2, revealed two systemic recurrences, both in patients with poor prognostic markers at the time of surgery, but no local recurrence. Conclusions. OPN has complication rates similar to open radical nephrectomy. Long-term tumour control in unilateral cases and with organ confined disease is excellent. The results demonstrate that carefully performed OPN at a medium-volume centre can achieve equal results to high-volume centres.

Key Words::

• Oncological outcome
• open partial nephrectomy
• patient volume
• postoperative complications
• renal cell cancer

Acknowledgements

Thanks to Stig Colleen for introducing the authors to the conservative surgical approach of localized renal cell cancer, Eva Ljunggren for excellent organizational support, the Oncological Centre of South Sweden, the University Research Funds and the Gösta Jönsson Research Foundation at Lund University Hospital, Lund, Sweden, for financial support.

Declaration of interest: The authors report no conflicts of interest.The authors alone is responsible for the content and writing of the paper.