Tumors in solitary kidneys are not all equal: Outcomes of partial nephrectomy in high-risk cases Journal Article
| Authors: | Dawidek, M. T.; Calderon, L. P.; Villada, J. S. A.; Ucpinar, B. A.; Eismann, L.; Reese, S. W.; Ganz, M.; Akin, O.; Reznik, E.; Coleman, J. A.; Hakimi, A. A.; Russo, P. |
| Article Title: | Tumors in solitary kidneys are not all equal: Outcomes of partial nephrectomy in high-risk cases |
| Abstract: | 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 (for radius, exophytic/endophytic, nearness of tumor to collecting system, anterior/posterior, location relative to polar line) 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. |
| Keywords: | renal cell carcinoma; nephrectomy; management; solitary kidney; preservation; renal masses; renal neoplasms |
| Journal Title: | Urology Practice |
| Volume: | 12 |
| Issue: | 4 |
| ISSN: | 2352-0779 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2025-07-01 |
| Start Page: | 441 |
| End Page: | 450 |
| Language: | English |
| ACCESSION: | WOS:001516943200001 |
| DOI: | 10.1097/upj.0000000000000802 |
| PROVIDER: | wos |
| PUBMED: | 40084969 |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF. Corresponding MSK author is Paul Russo -- Source: Wos |
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