Partial nephrectomy preserves renal function without increasing the risk of complications compared with radical nephrectomy for renal cell carcinomas of stages pT2–3a

Abstract

Objectives: To compare the operative and functional result of partial and radical nephrectomy in renal cell carcinomas of stages pT2-3a. Methods: Consecutive patients with renal cell carcinoma of stages pT2-3a, cN0 and cM0, who underwent partial or radical nephrectomy between January 2005 and October 2019 at a tertiary care center were included. Data were collected retrospectively. Endpoints included severe postoperative complications (Clavien-Dindo classification ≥3), acute and chronic renal function impairment, and overall survival. Uni-and multivariable outcome analyses were based on logistic regression. Results: A total of 158 patients were included (110 radical nephrectomy and 48 partial nephrectomy). Over time, partial nephrectomy was increasingly used. A RENAL score ≥10 was the only independent predictor influencing the surgical approach (radical nephrectomy vs partial nephrectomy, odds ratio 8.62, 95% confidence interval 3.32-22.37, P < 0.001). No significant differences in complications for radical nephrectomy versus partial nephrectomy were found (12.7% vs 8.3%, P = 0.424). Renal function was better preserved in the partial nephrectomy group (the latest chronic kidney disease stage ≥3: radical nephrectomy 73% vs partial nephrectomy 41%, P = 0.005). The surgical approach was a significant factor for chronic kidney disease (odds ratio 51.07, 95% confidence interval 3.57-730.59, P = 0.004). Overall survival did not significantly differ between radical nephrectomy and partial nephrectomy (mean overall survival 85.86 months, 95% confidence interval 3.83-78.36 vs 81.28 months, 95% confidence interval 4.59-72.29, P = 0.702). Conclusions: In selected patients, partial nephrectomy can be used in large or locally advanced renal cell carcinoma. Compared with radical nephrectomy, it allows better preservation of renal function without harboring an increased risk of severe postoperative complications.

Partial versus radical nephrectomy in clinical T2 renal masses

“…These results will require confirmation in future studies. It is encouraging, however, that the present data are consistent with prior studies that also found approach (PN vs RN) has no statistically significant negative impact on OS, MFS or CSS for cT2 renal masses 4,9–11,13,16,19 . Approach was significantly associated with OCS (RN vs PN HR 0.5, P = 0.04).…”

“…The rates of overall (19%) and severe (4%) complications after PN in the present study compare favorably with prior reports 3,6,7,9,10,16 . Increased complication rates associated with PN, as compared with RN, are not surprising given generally increased surgical complexity.…”

“…Muhlbauer et al . retrospectively analyzed 158 patients (48 PN/110 RN) with pT2‐3a RCC who underwent PN or RN at a single institution 10 . They concluded that PN, as compared with RN, preserves renal function with no significant difference in morbidity or survival.…”

A meta-analysis for comparison of partial nephrectomy vs. radical nephrectomy in patients with pT3a renal cell carcinoma

“…A total of 3,391 patients were included, including 1,278 patients in the PN group, 2,113 patients in the RN group. Among the nine studies, two of them compared the tumor-specific survival rates between RN and PN group (19,22), five studies compared OS rates (18)(19)(20)(21)(22), two studies compared CSM (17,20), three studies compared RFS (18,23,24), three studies compared complications (20,22,25) and five studies compared positive surgical margin (18,20,(22)(23)(24). The baseline characteristics of included studies were shown in Table 2.…”

Re: Editorial Comment from Dr Bertolo et al. to Partial nephrectomy preserves renal function without increasing the risk of complications compared with radical nephrectomy for renal cell carcinomas of stages pT2–3a

“…We read the Editorial Comment by Bertolo et al 1 . with great interest and thank the authors for their interest in our work regarding the comparison of partial nephrectomy (PN) versus radical nephrectomy (RN) for patients with renal cell carcinomas (RCC) of stages pT2–3a 2 …”