Patients who undergo minimally invasive partial nephrectomy (MIPN) for renal cell carcinoma rarely experience recurrence of the cancer, according to researchers.
In a study of 417 patients who underwent MIPN for mostly pT1 tumors, the estimated recurrence-free survival rates at two, five, and 10 years were 98.2%, 93.5%, and 88.3%, respectively, J. Stuart Wolf, Jr., MD, and colleagues at the University of Michigan Hospitals and Health Centers in Ann Arbor reported online ahead of print in the Journal of Endourology. The estimated overall survival rates were 95.6%, 89.1%, and 70.7%, respectively. Only one cancer-related death occurred.
Study subjects had a mean tumor size of 2.9 cm and only 6.7% of patients had a pathologic stage T2 or greater. The median overall and oncologic follow-up was 3.3 and 2.9 years, respectively. Patients underwent standard, hand-assisted, or robotic-assisted laparoscopy.
On multivariate analysis, only tumor stage was associated with recurrence and only patient age and American Society of Anesthesiologists (ASA) score were associated with overall survival. Compared with patients who had stage pT1a tumors, those with pT1b and pT2 or greater tumors were 4.8 times and 19 times more likely to experience recurrence, respectively. Each additional year of age was associated with a 5% increased risk of death. Compared with an ASA score of 1 or 2, a score of 3 or 4 was associated with a 3.5 times increased risk of death, Dr. Wolf's group reported.
“With limited impact of these small renal cancers on mortality, the clinician's operative decisions should be guided by the understanding that recurrence-free survival is influenced by tumor stage and that overall survival is influenced by patients' age and medical condition,” the authors concluded.
Results showed that the technical aspects of MIPN, such as surgical approach or method of resecting the tumor, were not associated with recurrence, according to the researchers.
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