Survival outcomes in patients with large (≥7cm) clear cell renal cell carcinomas treated with nephron-sparing surgery versus radical nephrectomy: Results of a multicenter cohort with long-term follow-up.

BACKGROUND: Does the dogma of nephron sparing surgery (NSS) still stand for large renal masses? Available studies dealing with that issue are considerably biased often mixing imperative with elective indications for NSS and also including less malignant variants or even benign renal tumors. Here, we analyzed the oncological long-term outcomes of patients undergoing elective NSS or radical tumor nephrectomy (RN) for non-endophytic, large (≥7cm) clear cell renal carcinoma (ccRCC). METHODS: Prospectively acquired, clinical databases from two academic high-volume centers were screened for patients from 1980 to 2010. The query was strictly limited to patients with elective indications. Surgical complications were retrospectively assessed and classified using the Clavien-Dindo-classification system (CDS). Overall survival (OS) and cancer specific survival (CSS) were analyzed using the Kaplan-Meier-method and the log-rank test. RESULTS: Out of in total 8664 patients in the databases, 123 patients were identified (elective NSS (n = 18) or elective RN (n = 105)) for ≥7cm ccRCC. The median follow-up over all was 102 months (range 3-367 months). Compared to the RN group, the NSS group had a significantly longer median OS (p = 0.014) and median CSS (p = 0.04). CONCLUSIONS: In large renal masses, NSS can be performed safely with acceptable complication rates. In terms of long-term OS and CSS, NSS was at least not inferior to RN. Our findings suggest that NSS should also be performed in patients presenting with renal tumors ≥7cm whenever technically feasible. Limitations include its retrospective nature and the limited availability of data concerning long-term development of renal function in the two groups.

Diagnostic confusion in mild traumatic brain injury (MTBI). Lessons from clinical practice and EFNS--inquiry. European Federation of Neurological Societies.

A 1997 inquiry of 130 neurosurgeons throughout Germany, dealing with diagnosis and therapy of patients with mild traumatic brain injury showed a mainly inhomogeneous picture. The European Federation of Neurological Societies inquiry form 'Management of Patients with Mild Head Injury' was sent on behalf of the German Society of Neurological Surgeons to every leading neurosurgeon in Germany, of whom only 74 (57%) answered. The diagnosis 'mild brain injury' is used by 63%, 'commotio cerebri' by 49%, and 'brain concussion' by 4% of the institutions. GCS is used for classification by 60%, PTA 48%, retrograde amnesia by 50%, and LOC by 63% of institutions. Guidelines are used in 78%. Diagnostic x-ray of the skull is used in 77%, cervical spine in 62%, CT in 66%, MRT in 7%; and routine EEG in 35%. Fourteen per cent of the patients are not admitted; home observation is used in 45% of institutions, full bedrest in 19%, working pause in 48%, pain medication in 27%, control in 51%. Seperate guidelines for children in 54% of those departments.