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