Clinical, pathologic, and functional outcomes after nephron-sparing surgery in patients with a solitary kidney: a multicenter experience.

Published

Journal Article

BACKGROUND AND PURPOSE: Surgical management of a renal neoplasm in a solitary kidney is a balance between oncologic control and preservation of renal function. We analyzed patients with a renal mass in a solitary kidney undergoing nephron-sparing procedures to determine perioperative, oncologic, and renal functional outcomes. PATIENTS AND METHODS: A multicenter study was performed from 12 institutions. All patients with a functional or anatomic solitary kidney who underwent nephron-sparing surgery for one or more renal masses were included. Tumor size, complications, and recurrence rates were recorded. Renal function was assessed with serum creatinine level and estimated glomerular filtration rate. RESULTS: Ninety-eight patients underwent 105 ablations, and 100 patients underwent partial nephrectomy (PN). Preoperative estimated glomerular filtration rate (eGFR) was similar between the groups. Tumors managed with PN were significantly larger than those managed with ablation (P<0.001). Ablations were associated with a lower overall complication rate (9.5% vs 24%, P=0.01) and higher local recurrence rate (6.7% vs 3%, P=0.04). Eighty-four patients had a preoperative eGFR ≥60 mL/min/1.73 m(2). Among these patients, 19 (23%) fell below this threshold after 3 months and 15 (18%) at 12 months. Postoperatively, there was no significant difference in eGFR between the groups. CONCLUSIONS: Extirpation and ablation are both reasonable options for treatment. Ablation is more minimally invasive, albeit with higher recurrence rates compared with PN. Postoperative renal function is similar in both groups and is not affected by surgical approach.

Full Text

Duke Authors

Cited Authors

  • Mues, AC; Korets, R; Graversen, JA; Badani, KK; Bird, VG; Best, SL; Cadeddu, JA; Clayman, RV; McDougall, E; Barwari, K; Laguna, P; de la Rosette, J; Kavoussi, L; Okhunov, Z; Munver, R; Patel, SR; Nakada, S; Tsivian, M; Polascik, TJ; Shalhav, A; Shingleton, WB; Johnson, EK; Wolf, JS; Landman, J

Published Date

  • October 2012

Published In

Volume / Issue

  • 26 / 10

Start / End Page

  • 1361 - 1366

PubMed ID

  • 22667344

Pubmed Central ID

  • 22667344

Electronic International Standard Serial Number (EISSN)

  • 1557-900X

Digital Object Identifier (DOI)

  • 10.1089/end.2012.0114

Language

  • eng

Conference Location

  • United States