Functional and Oncological Outcomes of Partial Nephrectomy of Solitary Kidneys

Purpose

We examined outcomes after partial nephrectomy in patients with tumors in a solitary kidney to determine the extent to which patient, surgery and tumor specific variables influenced the glomerular filtration rate and local recurrence postoperatively.

Materials and Methods

Demographics, renal function, comorbidities, renal cell carcinoma history, and operative and pathological data were recorded. The effect on changes in early and late postoperative glomerular filtration rate and local recurrence were analyzed.

Results

In 84 patients undergoing a total of 89 partial nephrectomies the mean immediate postoperative decrease in the glomerular filtration rate in those with no ischemia, warm ischemia (mean 12 minutes) and cold ischemia (mean 33 minutes) was 29%, 37% and 45%, respectively (p <0.01). Late glomerular filtration rate decreases were 12%, 6% and 16%, respectively (p = 0.17). Cold ischemia and multiple vascular risk factors were associated with immediate glomerular filtration rate decreases (p = 0.008 and 0.04, respectively). Local recurrence, which developed in 13 patients (18%), was associated with positive margins and T stage (p = 0.01 and 0.02, respectively). End stage renal disease developed in 3 patients (4%) and an additional 5 (6%) required nephrectomy for local recurrence.

Conclusions

Partial nephrectomy generally results in a small decrease in the glomerular filtration rate, and limited warm and cold ischemia does not appear to adversely affect long-term renal function. Positive margins and T stage greater than 2 are the most important predictors of local recurrence in a solitary kidney. They pose a significant risk to end stage renal disease-free survival due to the need for completion nephrectomy in many of these patients. Partial nephrectomy should be considered the standard of care in all patients with tumor in the solitary kidney.

Key Words: kidney, nephrectomy, kidney failure, chronic, carcinoma, renal cell, neoplasm recurrence, local

Abbreviations and Acronyms: CKD, chronic kidney disease, EBL, estimated blood loss, ESRD, end stage renal disease, GFR, glomerular filtration rate, LR, local recurrence, PN, partial nephrectomy, RCC, renal cell carcinoma, RN, radical nephrectomy, VHL, von Hippel-Lindau disease