Functional results of partial nephrectomy in solitary functioning kidney tumors

Objective: to assess the early and late functional results of partial nephrectomy in patients with solitary functioning kidney tumors.

Materials and methods. Medical data of 131 consecutive patients with solitary kidney parenchymal tumor, who had undergone partial nephrectomy at the N. N. Blokhin Russian Cancer Research Center, were analyzed. The median age was 57 (26–75) years. All the patients were diagnosed with solitary kidney tumor (median RENAL score was 7.0 ± 2.4 and median PADUA score was 9.0 ± 2.2). The median baseline glomerular filtration rate (GFR) was 74 (33–159) ml/min/1.73 m2 (30 (22.9 %) – stage III chronic kidney disease (CKD) and 0 (0 %) – stages IV–V CKD). All the patients underwent partial nephrectomy (with ischemia in 98 (74.8 %) patients, including cold ischemia in 59 (45.1 %)). The median time of ischemia was 24 (7–80) min. The median blood loss was 800 (20–4500) ml.

Results. Acute renal injury was recorded in 69 (52.7 %) cases; 6 patients (4.6 %) had indications for acute dialysis. The independent risk factors of acute renal injury were sinus invasion (hazard ratio (HR) 0.08; 95 % confidence interval (CI) 0.03–0.22; p = 0.051), baseline GFR <80 ml/min/1.73 m2 (HR 0.45; 95 % CI 0.22–0.92; p = 0.021), parenchymal ischemia (HR 0.13; 95 % CI 0.05–0.33; p = 0.032), and >500-ml blood loss (HR 0.24; 95 % CI 0.12–0.51; p = 0.005). Progression of previously diagnosed CKD was recorded in 58 (44.6 %) patients; chronical dialysis was required in 2 (1.5 %) patients. The independent risk factors of CKD progression were sinus invasion (HR 0.38; 95 % CI 0.18–0.81; p = 0.002), medial location of the tumor (HR 0.19; 95 % CI 0.09–0.41; p = 0.001), baseline GFR, <60 ml/min/1.73 m2 (HR 0.24; 95 % CI 0.10–0.56; p <0.0001), warm ischemia (HR 0.41; 95 % CI 0.17–1.00; p = 0.052).

Conclusion. Solitary kidney resection is associated with a low risk for renal function loss. To achieve optimal functional results, it is desirable to follow the balance between the indications for renal vessel ligation and the need to avoid >500-ml blood loss and cold ischemia.

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