Tumors in Solitary Kidneys Are Not All Equal: Outcomes of Partial Nephrectomy in High-Risk Cases.
Mark T Dawidek, Lina Posada Calderon, Juan Sebastian Arroyave Villada, Burcin A Ucpinar, Lennert Eismann, Stephen W Reese, Marc Ganz, Oguz Akin, Ed Reznik, Jonathan A Coleman, A Ari Hakimi, Paul Russo
Author Information
Mark T Dawidek: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York. ORCID
Lina Posada Calderon: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Juan Sebastian Arroyave Villada: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Burcin A Ucpinar: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
Lennert Eismann: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Stephen W Reese: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Marc Ganz: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Oguz Akin: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
Ed Reznik: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
Jonathan A Coleman: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
A Ari Hakimi: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Paul Russo: Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
INTRODUCTION: While partial nephrectomy remains the preferred treatment of tumors in solitary kidneys, there is a broad range of complexity to these cases. This retrospective study refines our understanding of renal and oncologic outcomes in high-risk cases of partial nephrectomy of the solitary kidney (PNSK). METHODS: Review of our institutional database identified patients who underwent PNSK between 1990 and 2020. Cases were classified as high-risk PNSK based on having any of the following: clinical stage ��� T3, RENAL nephrometry score ��� 10, or multiple tumors suspicious for malignancies. RESULTS: Of the 124 cases included, 73 were classified as high-risk PNSK. The rate of high-grade perioperative complications was 32% among high-risk cases, compared with 12% among low-risk cases. The high-risk group recovered less of their baseline renal function compared with the low-risk group, although this gap narrowed with time, and the respective 5-year end-stage renal disease-free survivals were 89% and 100%. Baseline renal function, multifocal tumors, and intraoperative blood loss were predictors of long-term renal function. The 5-year local recurrence-free survival, cancer-specific survival, and overall survival rates in the high-risk group were 83%, 80%, and 77%, respectively. CONCLUSIONS: Outcomes of PNSK remain preferrable to end-stage renal disease in the highest risk patients. Keys to optimization are meticulous preservation of normal parenchyma and a bloodless field. Longer ischemia time is tolerable to achieve these goals, although it may benefit from the application of renal hypothermia.
