Comparative analysis of results of radical nephrectomy and partial nephrectomy for clinically localized renal cell carcinoma in patients with normal functioning contralateral kidney


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Abstract

The study was aimed to the evaluation of the safety and feasibility of partial nephrectomy for clinically localized renal cell carcinoma in patients with a normally functioning contralateral kidney. A comparative analysis of the results of radical nephrectomy (n = 226) and partial nephrectomy (n = 227) in patients with cT1 -2N0M0 renal cancer with normally functioning contralateral kidney was performed. Groups of patients subjected to different extent of operations were matched by sex, age, side of lesion, baseline characteristics of the tumor, and renal function (P> 0.05 for all); pT1a category and degree G1of anaplasia were more often diagnosed in the partial nephrectomy group (P < 0.0001). None of the 453 patients has received additional treatment. Median follow-up period was 50 (12-224) months. It was found that partial nephrectomy is associated with a significant increase in the duration of surgery (P = 0.031), blood loss volume (P <0.000), and the risk of complications (OR = 2.8 (95% CI: 1.64.7); P < 0.0001) compared with radical nephrectomy. Complications of partial nephrectomy do not increase the risk of decline in renal function and death. Partial nephrectomy is comparable to radical nephrectomy in terms of recurrence free survival (HR = 5.9 ( 95 % CI: 0.9-38.3)), specific survival (HR = 0.1 ( 95% CI : 0-12555.9 )) cardiospecific survival (HR = 1.1 ( 95 % CI: 0.3-4.6)), and overall survival (HR = 0.8 ( 95 % CI: 0.2-2.5)), including stratification of patients by demographic characteristics, characteristics of the tumor and postoperative renal function (P> 0.05 for all). Nephrectomy increases the risk of acute renal dysfunction by 1.8 times and reduces the risk of developing stage ≥ 3 chronic kidney disease in the late postoperative period by 1.4 times compared with radical nephrectomy. The effects of extent of operations on the quality of life were not revealed. Thus, the use of partial nephrectomy allows to improve the longterm functional results of surgical treatment for clinically localized renal cell carcinoma, and is associated with an increased incidence of complications that do not lead, however, to a decrease in survival compared with radical nephrectomy. The choice of method of surgical treatment of such patients should be individualized.

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About the authors

M. I Volkova

FSBI “RORC n.a. N.N. Blokhin RAMS”

Email: mivolkova@rambler.ru
Senior Scientist at the Department of Urology

I. Ya Skvortsov

FSBI “RORC n.a. N.N. Blokhin RAMS”

A. V Klimov

FSBI “RORC n.a. N.N. Blokhin RAMS”

V. A Chernyaev

FSBI “RORC n.a. N.N. Blokhin RAMS”

S. A Kalinin

FSBI “RORC n.a. N.N. Blokhin RAMS”

M. V Peters

FSBI “RORC n.a. N.N. Blokhin RAMS”

V. B Matveev

FSBI “RORC n.a. N.N. Blokhin RAMS”

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