A Contemporary Experience With Partial Nephrectomy For Patients With A Solitary Kidney: A Single Institution Analysis

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy III (MP42)1 Sep 2021MP42-13 A CONTEMPORARY EXPERIENCE WITH PARTIAL NEPHRECTOMY FOR PATIENTS WITH A SOLITARY KIDNEY: A SINGLE INSTITUTION ANALYSIS Stanley Weng, Renzo DiNatale, Andrew Silagy, Kyrollis Attalla, Kate Weiss, Angela Yoo, Nicole Benfante, Jonathan Coleman, A Ari Hakimi, and Paul Russo Stanley WengStanley Weng More articles by this author , Renzo DiNataleRenzo DiNatale More articles by this author , Andrew SilagyAndrew Silagy More articles by this author , Kyrollis AttallaKyrollis Attalla More articles by this author , Kate WeissKate Weiss More articles by this author , Angela YooAngela Yoo More articles by this author , Nicole BenfanteNicole Benfante More articles by this author , Jonathan ColemanJonathan Coleman More articles by this author , A Ari HakimiA Ari Hakimi More articles by this author , and Paul RussoPaul Russo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002063.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with renal tumors in a solitary kidney can represent a challenge to urologists. These patients will typically be offered partial nephrectomy (PN) to spare renal parenchyma and preserve kidney function. We sought to characterize postoperative kidney function and oncologic outcomes based on preoperative estimated glomerular filtration rate (GFR) within this unique cohort of patients. METHODS: We queried our institutional database for patients who had solitary kidneys and underwent subsequent PN with available preoperative GFRs. To assess postoperative renal function, each patient’s monthly average GFR trajectory was plotted, from the immediate preoperative GFR through twelve months postoperatively. Locally weighted scatterplot smoothing was then used to observe trends. New baseline GFR was defined as the maximum GFR obtained within six months after surgery. Overall survival (OS) and cancer-specific survival (CSS) estimates were calculated from the time of nephrectomy to death or last follow-up using the Kaplan-Meier method. RESULTS: We identified 145 patients with a median age of 62 years [IQR:57,71]. Nearly two-thirds (65%) of patients had hypertension and 14% had diabetes. Prior to PN, 96 (66%) patients had a GFR less than 60ml/min/1.73m2. Median preoperative GFR was 52ml/min/1.73m2 [IQR:44,65]. Median tumor size was 3cm [IQR:2,4]. More patients received open surgery compared to minimally invasive surgery (89% vs 11%). 63% of PNs were performed on-clamp with a median clamp time of 36 minutes [IQR:26,47]. Temporary hemodialysis was required in twelve patients (8%) after surgery. Notably, patients with preoperative GFR ≥ 60ml/min/1.73m2 had a larger decrease in baseline GFR (14 vs 5, Wilcoxon rank-sum, p=0.002) but had a higher median new baseline GFR (58 vs 41, Wilcoxon rank-sum, p <0.001) by six months (Figure 1). After a median follow-up of 65 months, no CSS (log-rank, p=0.4) and OS (log-rank, p=0.2) survival differences were observed between these two groups. CONCLUSIONS: PNs for tumors in a solitary kidney can be a safe and effective management strategy that allows patients to be rendered tumor free. Although the detrimental impact of this procedure on kidney function is indisputable, many patients are able to recover to new stable baseline levels by six months post-op. Source of Funding: The Sidney Kimmel Center for Prostate and Urologic Cancers and in part through the NIH/NCI Cancer Center Support Grant P30 CA008748 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e776-e777 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stanley Weng More articles by this author Renzo DiNatale More articles by this author Andrew Silagy More articles by this author Kyrollis Attalla More articles by this author Kate Weiss More articles by this author Angela Yoo More articles by this author Nicole Benfante More articles by this author Jonathan Coleman More articles by this author A Ari Hakimi More articles by this author Paul Russo More articles by this author Expand All Advertisement PDF DownloadLoading ...