Impact of surgical volume on functional results and cardiospecific survival rates in patients with clinically localized renal cancer

Objective: to analyze the impact of surgical volume on functional results and cardiospecific survival rates in patients with clinically localized renal carcinoma.

Subjects and methods. Four hundred and fifty-three patients with pT1–3aN0M0 renal cell carcinoma and normally functioning second
kidney who had undergone radical nephrectomy (n = 226 (49.9 %)) or kidney resection (n = 227 (50.1 %)) were selected for the investigation. The patient groups who had undergone different-volume operations were matched for gender, age, body mass index (BMI), side of involvement, tumor sizes, and baseline glomerular filtration rate (GFR) (p > for all). The median baseline Charlson index and the rate of ASA classes III–IV operative risk were significantly higher in candidates for radical nephrectomy (p < 0.05 for all), the rate of diseases affecting kidney function, pT1a category, and G1 anaplasia were higher in the kidney resection group (p < 0.0001). The median follow-up was 50 (12–224) months.

Results. Within 28 days postsurgery, the rate of acute renal dysfunction (ARD) was 36.2 %. The independent risk factors of ARD were kidney resection (risk ratio (RR) = 0.210; 95 % confidence interval (CI) 0.115–0.288; р < 0.0001) and ischemia time (RR = 0.012; 95 % CI 0.004–0.021; p = 0.004). The degree of ARD after kidney resection was significantly lower than that following radical nephrectomy (p < 0.0001). In the late postoperative period, the incidence of chronic kidney disease (CKD) Stage ≥ III was 38.4 %. Its independent risk factors were low baseline GFR (RR = 0.003; 95 % CI 0.002–0.005; p < 0.0001), radical nephrectomy (RR = 0.195; 95 % CI 0.093–0.298; p < 0.0001), and ARD (RR = 0.281; 95 % CI 0.187–0.376; p = 0.0001). Ten-year specific and cardiospecific survival rates in all the patients were 98.5 and 94.9 %, respectively, and unrelated to surgical volume. The independent predictors of poor cardiospecific survival were BMI, Charlson index, and ASA risk. No relationship was found betwen cardiospecific survival and GFR in the late postoperative period.

Conclusion. Kidney resection versus radical nephrectomy significantly increases the risk of severe ARD. The scope of surgical treatment for clinically localized renal cancer has not been found to affect cardiospecific survival.