TY - JOUR
T1 - Partial versus radical nephrectomy for complex renal mass
T2 - multicenter comparative analysis of functional outcomes (Rosula collaborative group)
AU - Cerrato, Clara
AU - Meagher, Margaret
AU - Autorino, Riccardo
AU - Simone, Giuseppe
AU - Yang, Bo
AU - Uzzo, Robert G.
AU - Kutikov, Alexander
AU - Porpiglia, Francesco
AU - Capitanio, Umberto
AU - Montorsi, Francesco
AU - Porter, James R.
AU - Beksac, Alp T.
AU - Puri, Dhruv
AU - Nguyen, Mimi
AU - Wang, Luke
AU - Hakimi, Kevin
AU - Dhanji, Sohail
AU - Liu, Franklin
AU - Cerruto, Maria A.
AU - Pandolfo, Savio D.
AU - Minervini, Andrea
AU - Lau, Clayton
AU - Monish, Aron
AU - Eun, Daniel D.
AU - Mottrie, Alexandre
AU - Mir, Carmen
AU - Sundaram, Chandru P.
AU - Antonelli, Alessandro
AU - Kaouk, Jihad
AU - Derweesh, Ithaar H.
N1 - Publisher Copyright:
© 2023 World Journal of Emergency Medicine
PY - 2023/8/1
Y1 - 2023/8/1
N2 - BACKGROUND: Utility of partial nephrectomy (PN) for complex renal mass (CRM) is controversial. We determined the impact of surgical modality on postoperative renal functional outcomes for CRM. METHODS: We retrospectively analyzed a multicenter registry (ROSULA). CRM was defined as RENAL Score 10-12. The cohort was divided into PN and radical nephrectomy (RN) for analyses. Primary outcome was development of de-novo estimated glomerular filtration rate (eGFR)<45 mL/min/1.73 m2. Secondary outcomes were de-novo eGFR<60 and ΔeGFR between diagnosis and last follow-up. Cox proportional hazards was used to elucidate predictors for de-novo eGFR<60 and <45. Linear regression was utilized to analyze ΔeGFR. Kaplan-Meier Analysis (KMA) was performed to analyze 5-year freedom from de-novo eGFR<60 and <45. RESULTS: We analyzed 969 patients (RN=429/PN=540; median follow-up 24.0 months). RN patients had lower BMI (P<0.001) and larger tumor size (P<0.001). Overall postoperative complication rate was higher for PN (P<0.001), but there was no difference in major complications (Clavien III-IV; P=0.702). MVA demonstrated age (HR=1.05, P<0.001), tumor-size (HR=1.05, P=0.046), RN (HR=2.57, P<0.001), and BMI (HR=1.04, P=0.001) to be associated with risk for de-novo eGFR<60 mL/min/1.73 m2. Age (HR=1.03, P<0.001), BMI (HR=1.06, P<0.001), baseline eGFR (HR=0.99, P=0.002), tumor size (HR=1.07, P=0.007) and RN (HR=2.39, P<0.001) were risk factors for de-novo eGFR<45 mL/min/1.73 m2. RN (B=-10.89, P<0.001) was associated with greater ΔeGFR. KMA revealed worse 5-year freedom from de-novo eGFR<60 (71% vs. 33%, P<0.001) and de-novo eGFR<45 (79% vs. 65%, P<0.001) for RN. CONCLUSIONS: PN provides functional benefit in selected patients with CRM without significant increase in major complications compared to RN, and should be considered when technically feasible. (Cite this article as: Cerrato C, Meagher MF, Autorino R, Simone G, Yang B, Uzzo RG, et al. Partial versus radical nephrectomy for complex renal mass: multicenter comparative analysis of functional outcomes (Rosula collaborative group).
AB - BACKGROUND: Utility of partial nephrectomy (PN) for complex renal mass (CRM) is controversial. We determined the impact of surgical modality on postoperative renal functional outcomes for CRM. METHODS: We retrospectively analyzed a multicenter registry (ROSULA). CRM was defined as RENAL Score 10-12. The cohort was divided into PN and radical nephrectomy (RN) for analyses. Primary outcome was development of de-novo estimated glomerular filtration rate (eGFR)<45 mL/min/1.73 m2. Secondary outcomes were de-novo eGFR<60 and ΔeGFR between diagnosis and last follow-up. Cox proportional hazards was used to elucidate predictors for de-novo eGFR<60 and <45. Linear regression was utilized to analyze ΔeGFR. Kaplan-Meier Analysis (KMA) was performed to analyze 5-year freedom from de-novo eGFR<60 and <45. RESULTS: We analyzed 969 patients (RN=429/PN=540; median follow-up 24.0 months). RN patients had lower BMI (P<0.001) and larger tumor size (P<0.001). Overall postoperative complication rate was higher for PN (P<0.001), but there was no difference in major complications (Clavien III-IV; P=0.702). MVA demonstrated age (HR=1.05, P<0.001), tumor-size (HR=1.05, P=0.046), RN (HR=2.57, P<0.001), and BMI (HR=1.04, P=0.001) to be associated with risk for de-novo eGFR<60 mL/min/1.73 m2. Age (HR=1.03, P<0.001), BMI (HR=1.06, P<0.001), baseline eGFR (HR=0.99, P=0.002), tumor size (HR=1.07, P=0.007) and RN (HR=2.39, P<0.001) were risk factors for de-novo eGFR<45 mL/min/1.73 m2. RN (B=-10.89, P<0.001) was associated with greater ΔeGFR. KMA revealed worse 5-year freedom from de-novo eGFR<60 (71% vs. 33%, P<0.001) and de-novo eGFR<45 (79% vs. 65%, P<0.001) for RN. CONCLUSIONS: PN provides functional benefit in selected patients with CRM without significant increase in major complications compared to RN, and should be considered when technically feasible. (Cite this article as: Cerrato C, Meagher MF, Autorino R, Simone G, Yang B, Uzzo RG, et al. Partial versus radical nephrectomy for complex renal mass: multicenter comparative analysis of functional outcomes (Rosula collaborative group).
KW - Carcinoma, renal Cell
KW - Glomerular Filtration Rate
KW - Nephrectomy
KW - Renal insufficiency, chronic
UR - http://www.scopus.com/inward/record.url?scp=85166156223&partnerID=8YFLogxK
UR - https://doi.org/10.23736/S2724-6051.23.05123-6
U2 - 10.23736/S2724-6051.23.05123-6
DO - 10.23736/S2724-6051.23.05123-6
M3 - Article
C2 - 37530659
SN - 2724-6051
VL - 75
SP - 425
EP - 433
JO - Minerva Urology and Nephrology
JF - Minerva Urology and Nephrology
IS - 4
ER -