EURURO-6248; No. of Pages 3 EUROPEAN UROLOGY XXX (2015) XXX–XXX
available at www.sciencedirect.com journal homepage: www.europeanurology.com
Platinum Priority – Editorial Referring to the article published on pp. x–y of this issue
Understanding Chronic Kidney Disease of Surgical Versus Medical Origin: The Missing Link to the Partial Versus Radical Nephrectomy Debate? Daniel Parker, Alexander Kutikov, Robert G. Uzzo, Marc C. Smaldone * Division of Urologic Oncology, Department of Surgery, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
In the USA and Europe, nephron-sparing surgery (NSS) has become accepted as the gold standard for renal masses of 4 cm in size [1,2]. There is general consensus in the urologic community that the acceptable increase in perioperative surgical risk inherent to partial nephrectomy (PN) is justified by the theoretical benefit of avoiding the long-term deleterious renal functional consequences associated with radical nephrectomy (RN). Concerns regarding adverse events associated with a decline in glomerular filtration rate (GFR) [3], such as cardiovascular compromise, chronic anemia, bone demineralization, and metabolic disturbances, have resulted in the intuitive and widely embraced hypothesis that NSS may result in a survival advantage when comparing PN and RN. Enthusiasm for NSS was fueled by observational studies demonstrating large differences in overall survival favoring PN [4,5], and PN rates have accordingly increased over the past decade [6]. Because of robust evidence of the oncologic efficacy of nephron-sparing excision of tumors of
available at www.sciencedirect.com journal homepage: www.europeanurology.com
Platinum Priority – Editorial Referring to the article published on pp. x–y of this issue
Understanding Chronic Kidney Disease of Surgical Versus Medical Origin: The Missing Link to the Partial Versus Radical Nephrectomy Debate? Daniel Parker, Alexander Kutikov, Robert G. Uzzo, Marc C. Smaldone * Division of Urologic Oncology, Department of Surgery, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
In the USA and Europe, nephron-sparing surgery (NSS) has become accepted as the gold standard for renal masses of 4 cm in size [1,2]. There is general consensus in the urologic community that the acceptable increase in perioperative surgical risk inherent to partial nephrectomy (PN) is justified by the theoretical benefit of avoiding the long-term deleterious renal functional consequences associated with radical nephrectomy (RN). Concerns regarding adverse events associated with a decline in glomerular filtration rate (GFR) [3], such as cardiovascular compromise, chronic anemia, bone demineralization, and metabolic disturbances, have resulted in the intuitive and widely embraced hypothesis that NSS may result in a survival advantage when comparing PN and RN. Enthusiasm for NSS was fueled by observational studies demonstrating large differences in overall survival favoring PN [4,5], and PN rates have accordingly increased over the past decade [6]. Because of robust evidence of the oncologic efficacy of nephron-sparing excision of tumors of
