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

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 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.

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