Deterioration of renal function is associated with increased all-cause mortality. In renal masses larger than 4 cm, whether partial versus radical nephrectomy (PN vs. RN) might affect long-term functional outcomes is unknown. This study tested the association between PN versus RN and postoperative acute kidney injury (AKI), recovery of at least 90% of the preoperative estimated glomerular filtration rate (eGFR) at 1 year, upstaging of chronic kidney disease (CKD) one stage or more at 1 year, and eGFR decline of 45 ml/min/1.73 m2 or less at 1 year.
Data from 23 high-volume institutions were used. The study included only surgically treated patients with single, unilateral, localized, clinical T1b-2 renal masses. Multivariable logistic regression analyses were performed.
Overall, 968 PN patients and 325 RN patients were identified. The rate of AKI was lower in the PN versus the RN patients (17% vs. 58%; p < 0.001). At 1 year after surgery, for the PN versus the RN patients, the rate for recovery of at least 90% of baseline eGFR was 51% versus 16%, the rate of CKD progression of ≥ 1 stage was 38% versus 65%, and the rate of eGFR decline of 45 ml/min/1.73 m2 or less was 10% versus 23% (all p < 0.001). Radical nephrectomy independently predicted AKI (odds ratio [OR], 7.61), 1-year ≥ 90% eGFR recovery (OR, 0.30), 1-year CKD upstaging (OR, 1.78), and 1-year eGFR decline of 45 ml/min/1.73 m2 or less (OR, 2.36) (all p ≤ 0.002).
For cT1b-2 masses, RN portends worse immediate and 1-year functional outcomes. When technically feasible and oncologically safe, efforts should be made to spare the kidney in case of large renal masses to avoid the hazard of glomerular function loss-related mortality.
Annals of surgical oncology. 2024 May 27 [Epub ahead of print]
Stefano Tappero, Carlo Andrea Bravi, Zine Eddine Khene, Riccardo Campi, Angela Pecoraro, Pietro Diana, Chiara Re, Carlo Giulioni, Alp T Beksac, Riccardo Bertolo, Tarek Ajami, Kennedy E Okhawere, Margaret Meagher, Arman Alimohammadi, Carlo Terrone, Andrea Mari, Daniele Amparore, Luigi Da Pozzo, Umberto Anceschi, Nazareno Suardi, Antonio Galfano, Alessandro Larcher, Riccardo Schiavina, Erdem Canda, Xu Zhang, Shahrokh Shariat, Francesco Porpiglia, Alessandro Antonelli, Jihad Kaouk, Ketan Badani, Ithaar Derweesh, Alberto Breda, Alexander Mottrie, Paolo Dell'Oglio
IRCCS Ospedale Policlinico San Martino, Genova, Italy. ., Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK., Department of Urology, University of Rennes, Rennes, France., Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy., Department of Urology, Hospital Pederzoli, Peschiera del Garda, Verona, Italy., Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain., Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy., Unit of Urology, Jesi Hospital, Jesi, Ancona, Italy., Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy., Department of Urology, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain., Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA., University of California, San Diego, La Jolla, CA, USA., Department of Urology, Medical University of Vienna, Vienna, Austria., IRCCS Ospedale Policlinico San Martino, Genova, Italy., Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Clinical and Experimental Medicine, Careggi Hospital, University of Florence, Florence, Italy., Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy., ASST Papa Giovanni XXIII, Bergamo, Italy., Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy., Department of Urology, University of Brescia, Brescia, Italy., Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy., Department of Urology, Koç University Hospital, Istanbul, Turkey., Department of Urology, Chinese PLA General Hospital, Beijing, China., Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.