Utility of partial nephrectomy (PN) for complex renal mass (CRM) is controversial. We determined the impact of surgical modality on postoperative renal functional outcomes for CRM.
We retrospectively analyzed a multicenter registry (ROSULA). CRM was defined as RENAL Score 10-12. The cohort was divided into PN and radical nephrectomy (RN) for analyses. Primary outcome was development of de-novo estimated glomerular filtration rate (eGFR)<45 mL/min/1.73 m2. Secondary outcomes were de-novo eGFR<60 and ΔeGFR between diagnosis and last follow-up. Cox proportional hazards was used to elucidate predictors for de-novo eGFR<60 and <45. Linear regression was utilized to analyze ΔeGFR. Kaplan-Meier Analysis (KMA) was performed to analyze 5-year freedom from de-novo eGFR<60 and <45.
We analyzed 969 patients (RN=429/PN=540; median follow-up 24.0 months). RN patients had lower BMI (P<0.001) and larger tumor size (P<0.001). Overall postoperative complication rate was higher for PN (P<0.001), but there was no difference in major complications (Clavien III-IV; P=0.702). MVA demonstrated age (HR=1.05, P<0.001), tumor-size (HR=1.05, P=0.046), RN (HR=2.57, P<0.001), and BMI (HR=1.04, P=0.001) to be associated with risk for de-novo eGFR<60 mL/min/1.73 m2. Age (HR=1.03, P<0.001), BMI (HR=1.06, P<0.001), baseline eGFR (HR=0.99, P=0.002), tumor size (HR=1.07, P=0.007) and RN (HR=2.39, P<0.001) were risk factors for de-novo eGFR<45 mL/min/1.73 m2. RN (B=-10.89, P<0.001) was associated with greater ΔeGFR. KMA revealed worse 5-year freedom from de-novo eGFR<60 (71% vs. 33%, P<0.001) and de-novo eGFR<45 (79% vs. 65%, P<0.001) for RN.
PN provides functional benefit in selected patients with CRM without significant increase in major complications compared to RN, and should be considered when technically feasible.
Minerva urology and nephrology. 2023 Aug [Epub]
Clara Cerrato, Margaret F Meagher, Riccardo Autorino, Giuseppe Simone, Bo Yang, Robert G Uzzo, Alexander Kutikov, Francesco Porpiglia, Umberto Capitanio, Francesco Montorsi, James Porter, Alp T Beksac, Dhruv Puri, Mimi Nguyen, Luke Wang, Kevin Hakimi, Sohail Dhanji, Franklin Liu, Maria A Cerruto, Savio D Pandolfo, Andrea Minervini, Clayton Lau, Aron Monish, Daniel Eun, Alexandre Mottrie, Carmen Mir, Chandru Sundaram, Alessandro Antonelli, Jihad Kaouk, Ithaar H Derweesh
Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA., Division of Urology, VCU Health System, Richmond, VA, USA., Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy., Department of Urology, Changhai Hospital, Shanghai, China., Division of Urology and Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA., Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy., Division of Experimental Oncology, Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy., Swedish Urology Group, Seattle, WA, USA., Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy., Department of Urology, University of Florence, Florence, Italy., Division of Urology and Urologic Oncology, City of Hope Medical Center, Duarte, CA, USA., Institute of Urology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA., Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA., Department of Urology, OLV Hospital, Aalst, Belgium., Department of Urology, Hospital Universitario de la Ribera, Valencia, Spain., Department of Urology, Indiana University Health, Indianapolis, IN, USA., Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA - .