Abstract
Purpose: To compare the functional outcomes of patients who
underwent partial (PN) or radical nephrectomy (RN) for clinical T1 (cT1)
renal tumors using the Kidney Cancer Database of the Urooncology
Association, Turkey.
Methods: We retrospectively reviewed 1004 patients who
underwent PN and RN for cT1 renal tumors at multiple academic tertiary
centers between 2000 and 2018. Patients with preoperative end-stage
chronic kidney disease and/or metastatic disease were excluded.
Results: There were 452 patients in the PN group and 552
patients in the RN group. The eGFR was significantly reduced in both
groups on postoperative day one (PN=13.7 vs. RN=19.1 ml/min/1.73 m2:p <0.001). In the PN group, eGFR showed a tendency to
recover according to a quadratic pattern and reached preoperative levels
in the first and third years (95.6±28.8 ml/min/1.73 m2 and 96.9±28.9
ml/min/1.73 m2, respectively), with no significant difference between
the eGFRs in the 1st and 3rd years (p=0.710). To define groups at risk,
different cut-off values for the GFR were considered. Among patients
with a baseline GFR<90, the RN cohort had significantly lower
eGFRs in the first and third years than the PN cohort (p=0.02). Logistic
regression showed that comorbidities, coronary artery disease, diabetes
and hypertension had no adverse impacts on the changes in the eGFR
(p =0.60, p =0.13, and p =0.13, respectively).
Conclusion: For the treatment of stage T1 kidney tumors, the
first choice should be open or laparoscopic partial nephrectomy due to
the superior long-term preservation of renal function and overall
survival, regardless of age and comorbidities.
Keywords: Kidney cancer, Renal cell carcinoma, Nephrectomy,
Kidney function, Glomerular filtration rate.