AUA 2018: Tumor Enucleation: Functional Comparison with Standard Partial Nephrectomy

San Francisco, CA USA ( Suk-Ouichai, from the Glickman Urological and Kidney Institute, Cleveland Clinic presented her research on two nephron-sparing techniques used to treat renal cancer, conventional partial nephrectomy (PN) and tumor enucleation (TE) (Figure 1). TE is like PN but it spares more of the normal parenchymal tissue by dissecting along the avascular pseudocapsule. Therefore, it is thought that TE better preserves renal function compared to PN, however this remains up for debate. Her team sought to shed some light on this issue by analyzing and comparing the functional outcomes of TE and PN. Screen Shot 2018 05 24 at 4.27.16 PM

Data was gathered at two centers from 2008-2015 on patients managed with nephron-sparing surgery. Their primary outcomes were preservation of the ipsilateral parenchymal mass and global GFR. Parenchymal mass was estimated by comparing the vascularized parenchymal region on pre- and post-operative CT imaging. Global GFR was measured by pre- and post-operative serum creatinine.

They found no differences in tumor characteristics (i.e. tumor size, R.E.N.A.L. score) or pre-operative GFR between the TE (n=7) and PN (n=373). Capsular closure was more often performed in PN and the parenchymal mass was preserved more often in TE than PN (95% vs. 84%, p < 0.05). The global GFR preservation was higher in the TE vs. PN group, but they found a higher positive margin rate for TE vs. PN (8.5% vs. 4.8%, p < 0.05).

Dr. Suk-Ouichai concludes that TE can improve parenchymal mass preservation and renal function preservation, however the higher positive margin rate is concerning, and its clinical significance needs further evaluation.

Presented by: Chalairat Suk-Ouichai, MD

Written by: Egor Parkhomenko, Department of Urology, University of California-Irvine at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA