Renal function and oncologic outcomes in nephron sparing surgery for renal masses in solitary kidneys.

INTRODUCTION: With low life expectancy rates in hemodialysis patients, the preservation of renal parenchyma must be weighed against the oncological outcomes in considering partial nephrectomy (PN) in solitary kidneys. The main objective of this study was to assess the oncologic and functional outcomes after PN in patients with solitary kidneys.
METHODS: A retrospective analysis of the Columbia University Medical Center Urologic Oncology database found 38 patients who underwent PN in the setting of a solitary kidney from 1988-2008. Chronic kidney disease (CKD) was defined as GFR of <60 cc/min/1.73 m(2). Kaplan-Meier analysis was used to estimate overall survival, cancer-specific survival, and local recurrence-free survival.
RESULTS: The study group was followed for a median of 29 months, with a mean age of 63.2 years (range 35-83). Only one patient required postoperative long-term hemodialysis. Two out of 38 patients had a Clavien III postoperative complication. Twenty-one (55.3%) of the patients had preoperative CKD, while 29 (76%) patients had CKD postoperatively. Those who had CKD at the most recent follow-up had significantly larger tumors removed (P < 0.05). Of the 32 patients with renal cell carcinoma (RCC), 6 (18.8%) had a local recurrence at a median 32.6 months. The 5-year overall, disease-specific, and recurrence-free survival rates were 59.6, 77.5, and 45.7%, respectively.
CONCLUSION: PN in the setting of a solitary kidney poses difficult challenges for surgical and clinical management. Nephron sparing surgery for the treatment of RCC is feasible with low surgical complication rates, satisfactory disease-specific survival rates, and acceptable preservation of renal function.