No consensus exists on whether renal hilar tumors should be considered for radical (RN) or partial nephrectomy (PN). In this study we aim to describe the safety and efficacy of PN for surgically managed renal hilar tumors MATERIALS AND METHODS: : we retrospectively reviewed institutional records of patients with a small (<5 cm) solitary renal (hilar or non-hilar) mass who underwent PN or RN between 2008 and 2018. Hilar tumors were defined as those at medial position, abutting the renal vessels. Recurrence-free, cancer-specific, and overall survival were estimated using the Kaplan-Meier method.
Of 1,951 eligible patients, 399 had hilar tumors (292 scheduled for PN, 107 RN) and 1,552 had non-hilar tumors (scheduled for PN). We found no significant differences in survival measures between hilar and non-hilar tumors in patients selected for PN. Patients scheduled for PN for hilar tumors had higher rates of ≥grade II postoperative surgical complications compared to patients scheduled to receive PN for non-hilar tumors (13% vs 8.6%; log-rank P = 0.018) and non-statistically significantly elevated rates of ≥grade II complications compared to patients scheduled for RN for hilar tumors (13% vs 6.5%; difference 6%, 95% CI 0.4%, 13%; log-rank P = 0.07).
PN for hilar and non-hilar renal masses (<5cm) experience comparable oncologic outcomes though increased risk of complications for hilar masses. PN for hilar tumors was associated with better renal function and overall survival with non-statistically elevated risk of grade II or higher complications than RN. A renal tumor located at the hilum should not be a contra-indication for performing PN.
Urology. 2021 Jul 28 [Epub ahead of print]
Ricardo G Alvim, Amy L Tin, Lucas Nogueira, Nathan C Wong, Renato C Fonseca, Daniel D Sjoberg, A Ari Hakimi, Karim A Touijer, Paul Russo, Jonathan A Coleman
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: ., Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: ., Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Surgery Department, Urology Service, Federal University of Minas Gerais, Belo Horizonte, Brazil. Electronic address: ., Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: ., Surgery Department, Urology Service, Federal University of Minas Gerais, Belo Horizonte, Brazil. Electronic address: ., Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: ., Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: ., Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: ., Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: ., Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: .