Renal Function Outcomes in Patients Treated With Partial Nephrectomy Versus Percutaneous Ablation for Renal Tumors in a Solitary Kidney

Abstract

With judicious use of ischemia partial nephrectomy, even for more complex tumors, has short-term renal function outcomes similar to those of percutaneous ablation.

Is the R.E.N.A.L. Nephrometry Scoring System Predictive of the Functional Efficacy of Nephron Sparing Surgery in the Solitary Kidney?

“…22 While reporting nephrometry scores is relatively new, multiple studies have validated our mean renal nephrometry score of 7.36 as well as our distribution of low, intermediate and highly complex tumors as a representative series. 14,15,[22][23][24] Also, the mean tumor size of 3.7 cm in our series is comparable to that in larger studies. 9,25 However, there remains of paucity of data on the ability of nephrometry scoring to predict functional outcomes.…”

“…8,9,22 Seven patients had increased eGFR after NSS, which is not uncommon when examining previously published studies, which do not necessarily highlight this paradoxical finding. 9,23,24 Even when these aberrant values were excluded from analysis, no significant correlation was identified between the nephrometry scoring system and the eGFR decrease after PN. While the minimal appreciated eGFR decrease is a testament to the efficacy of NSS, there is clearly a need to optimize comorbidities that might affect renal function preoperatively.…”

“…9,25 However, there remains of paucity of data on the ability of nephrometry scoring to predict functional outcomes. 22,24 Cha et al reported a significant relationship between the eGFR decrease and tumor radius (that is, tumor diameter), proximity to the collecting system and central location. 22 However, in that study, in which each incremental increase in TNS was associated with a larger eGFR decrease, 5 (11.9) Highly complex (10)* 4 (9.5) * No lesions were scored 11 or 12.…”

Cryoablation for Small Renal Masses: Selection Criteria, Complications, and Functional and Oncologic Results

“…Overall, studies comparing renal function before and after CA, particularly in a solitary kidney setting [30], suggest a degree of functional decline following CA because proper application includes freezing of a tumor margin. However, in most cases this is not clinically significant.…”

“…The search returned a total of 11 noncomparative CA studies [7][8][9][10][11][12][13][14][15][16][17] and 8 comparative studies (including 2 metaanalyses) comparing CA methods (LCA vs PCA) or CA with other modalities [18][19][20][21][22][23][24][25]. Additional articles were included for assessment of long-term oncologic outcomes [26], functional results [27][28][29][30][31][32], salvage treatment options [33][34][35][36], and cost assessment [37][38][39].…”