Is technically complicated partial nephrectomy justified in renal cell carcinoma patients with normal contralateral kidney?

M. I. Volkova, V. A. Ridin, V. A. Cherniayev, A. V. Klimov, K. M. Figurin, A. A. Kirichek, V. B. Matveev
2020 Onkourologiâ  
Objective: to compare the results of partial (PN) and radical nephrectomy (RN) in patients with renal parenchymal tumors with nephrometric PADUA index ≥8 and/or RENAL index ≥7 and functioning contralateral kidney.Materials and methods. Medical data of 114 consecutive patients with renal cell carcinoma (RCC) cT1–3aN0M0 and functioning contralateral kidney were included into the study: 57 (50.0 %) persons undergone PN for tumors with nephrometric PADUA index ≥8 and/or RENAL index ≥7 (the main
more » ... ex ≥7 (the main group), and 57 (50.0 %) patients undergone RN (the control group). The groups were comparable with regards to demographic characteristics, nephrometric parameters, morphological tumor features, and baseline glomerular filtration rate (р >0.05 for all). Median follow-up – 52.0 ± 23.6 (9.1–138.5) months.Results. Technically complicated PNs were associated with an increase of median surgery time (by 39 min, р = 0.06), blood loss (by 319 ml, p within the groups. Chronic kidney disease (CKD) progression rate was significantly higher in RN than in PN group (40 % vs 31.6 % respectively, р = 0.050), including more frequent development of CKD stages III–IV (31.6 % vs 26.3 % respectively; р = 0.034). There was no difference of long-term survival between PN and RN groups, and that included survival results stratified according to gender, age, baseline CKD stage, PADUA and RENAL indexes. Five-year recurrence-free survival was 94.1 % vs 92.2 % (р = 0.223), cancer-specific survival – 92.3 % vs 90.8 % (р = 0.443), cardio-specific survival – 91.6 % vs 77.9 % (р = 0.549), overall survival – 89.8 % vs 70.7 % respectively (р = 0.858).Conclusion. PN is effective and safe method of treatment in patients with renal parenchymal tumors with PADUA index ≥8 and/or RENAL index ≥7 and functioning contralateral kidney, providing significant functional benefit without survival compromising when compared with RN.
doi:10.17650/1726-9776-2019-15-4-39-49 fatcat:5wfhc4eofnganevjkw5nzkkxki