Long-term oncological results of surgical treatment of localized renal tumors

Objective : to analyze the long-term oncological results of surgical treatment of patients with stage cT1-сТ2аN0M0 renal cell cancer. Materials and methods . The analysis included 326 patients who underwent partial nephrectomy (PN) in 210 (64.42 %) and radical nephrectomy (RN) - in 116 (35.58 %). Stage cT1a tumors were found in 129 (39.57 %), cT1b - in 149 (45.71 %), cT2a - in 48 (14.72 %) cases. PN and RN for cT1a was performed in 113 (53.81 %) and 16 (13.79 %), for cT1b -in 86 (40.95 %) and 63 (54.31 %), for cT2a - in 11 (5.24 %) and 37 (31.90 %) patients. We used open approach in 5 (1.53 %), laparoscopic in 148 (45.26 %) and robotic in 173 (53.21 %). The median follow-up was 49.9 [26.0; 81.4] months. Results . In the group of patients with stage cT1a disease, 4 recurrences of the tumor process were revealed (3 local recurrences after PN and 1 after RN). Seven deaths were recorded (4 after PR and 3 after RN). Two deaths occurred due to the progression of kidney cancer (1 after PN and 1 after RN). 5-year disease-free survival after PN and RN was 95.93 ± 2.32 % versus 92.31 ± 7.39 % ( p >0.05); 5-year overall survival - 96.48 ± 2.08 % versus 85.56 ± 9.65 % ( p >0.05); 5-year cancer-specific survival - 98.33 ± 1.65 % versus 92.25 ± 6.5 % ( p >0.05). In the group of patients with stage cT1b disease, 12 recurrences were revealed (5 after PN and 7 after RN). 14 deaths were recorded (4 after PN and 10 after RN). Four deaths were related to the development of kidney cancer (all after RN). 5-year disease-free survival after PN and RN was 92.97 ± 3.1 % versus 86.99 ± 4.64 % ( p >0.05); 5-year overall survival -95.1 ± 2.78 % versus 88.63 ± 4.4 % ( p >0.05); 5-year cancer-specific survival - 100 % versus 94.1 ± 3.33 % ( p >0,05). There were no recurrences of the oncological process or deaths after PN in the group of patients with the stage of cT2a disease during four years of follow-up. After RN six recurrences of the oncological process, four deaths (3 of them due to the progression of kidney cancer) were recorded. Thus, the disease-free survival at was 80.57 ± 7.15 %; overall survival - 90.28 ± 5.34 %; cancer-specific survival - 93.63 ± 4.37 %. Conclusion . PN is the priority treatment for renal cell cancer. Oncological results of nephron-sparing surgery are superior to the results of RN, however, these differences are not reliable and require a longer study.