SUO 2017: Multiplex Partial Nephrectomy In A Solitary Kidney: The NCI Experience With Partial Nephrectomy For Three or More Tumors in Comparison To Standard Partial Nephrectomy In A Solitary Kidney

Washington, DC ( Introduction: Multiplex partial nephrectomy (MxPNx) is the excision of three or more tumors during the same procedure and has been shown to have distinct outcomes compared to standard partial nephrectomy (sPNx) for 1 or 2 tumors. Outcomes for MxPNx in the setting of a solitary kidney has not been previously reported.

Methods: The authors report a retrospective review of a prospectively maintained database of patients undergoing PNx on a solitary kidney at the NIH from 2010 to present. Patients were stratified into MxPNx and SPNx groups by number of tumors removed. Resection of 1 or 2 tumors was termed sPNx, whereas excision of 3 or more tumors was classified as MxPNx.

Results: 94 patients who underwent 124 PNxs with a median follow-up of 26.9 months were included in analysis (median age 53.8 years). There were significant differences between sPNx and MxPNx, including percentage of robotic PNxs (15.4% vs. 50.0%, p=0.02), blood loss and intra-op transfusions (median 1.0 L vs. 2.3 L, p=0.001; 0.5 units vs. 5 units, p<0.001), and hospital stay (median 5.5 vs. 8.0 post-op days, p=0.001). While no difference in overall complication rate was seen between MxPNx and sPNx (56.3% vs. 66.7%, p=0.7). Of MxPNx patients, 6.4% required eventual long term hemodialysis (HD), whereas 4.7% sPNx patients required HD. Two MxPNx patients and 1 sPNx patient had a completion radical nephrectomy during a subsequent planned partial nephrectomy. No difference in eGFR at 3 and 12 months postoperatively was noted. Patients requiring MxPNx were more likely to have local recurrence (66.7% vs. 25.0%, p=0.01) and at a faster rate postoperatively (median 22.7 vs. 39.8 months).

Conclusion: MxPNx is feasible in a solitary kidney, with acceptable oncologic and renal functional outcomes. Though intra- and post=operative outcomes differ substantially, bridge and long term HD rates between groups are similar. In general, these procedures are successful in preserving native kidney function.

Presented by: Joseph Andrew Baiocco, National Institutes of Health, Bethesda, MD, USA

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, @GoldbergHanan, at the 18th Annual Meeting of the Society of Urologic Oncology, November 29-December 1, 2017 – Washington, DC