Reoperative partial nephrectomy (RePN) offers several advantages for the treatment of recurrent, multifocal renal masses. RePN has been previously demonstrated to be technical feasibility and delay the need for renal replacement therapy. However, there is still inherent complexity and known risks to reoperative nephrectomy. We studied the largest population of reoperative partial nephrectomies to characterize renal functional outcomes and the likelihood of intra- and post-operative complications.
Query of an institutional surgical registry was conducted. Demographic data, serum creatinine (SCr) for eGFR and protein dipstick results were assessed within 1 week prior to surgery, and postoperative function assessments were studied within a year of surgery. RePN was defined as serial surgical resection of the ipsilateral renal unit.
A total of 1131 PNs performed on 663 patients at a single center were retrospectively evaluated. In reoperative cases, median number of operations per renal unit was 2 (range: 2-6). There was a stepwise decline in eGFR with an average decline of 6.1 with each RePN. With each subsequent nephrectomy, surgical duration, estimated blood loss, and incidence of preoperative anemia increased. Postoperative eGFR showed a significant positive association with preoperative eGFR, while negative associations were found with age, number of previous ipsilateral partial nephrectomies, number of tumors, and largest tumor size. High-grade complications were associated with the number of ipsilateral partial nephrectomies, tumors count, and tumor size. Robotic or laparoscopic procedures exhibited a likelihood of Grade 3 or greater complications compared to open surgery.
RePN contributes to renal dysfunction and an increased risk of surgical complications. Intraoperative blood loss and surgical duration increase with subsequent nephrectomy. Such risks are dependent on the number of prior operative interventions on the kidney, suggesting a stepwise progression of surgical morbidity.
The Journal of urology. 2024 Jun 12 [Epub ahead of print]
Maria B Antony, Zach Kozel, Nikhil Gopal, Lauren Loebach, Adam R Metwalli, Sandeep Gurram, W Marston Linehan, Mark W Ball
Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Maryland.