In the evolving landscape of nephron-sparing surgery (NSS), the role of minimally invasive redo partial nephrectomy (rMIPN) for solitary renal cancer recurrence (RCR) remains debated, particularly considering its technical demands and perioperative risks. In this dual-institutional study, we aimed to investigate long-term perioperative, oncologic, and functional outcomes of rMIPN, comparing off- versus on-clamp hilar strategies.
Two prospectively maintained renal cancer databases were queried for patients undergoing rMIPN for ipsilateral solitary RCR between January 2004 and October 2024. Sixty-three patients were included and stratified by hilar control: off-clamp (Group A, N.=41) versus on-clamp (Group B, N.=22). Baseline, surgical, pathological, and renal functional outcomes were compared. Kaplan-Meier analysis assessed overall survival (OS), cancer-specific survival (CSS), and progression to CKD stage ≥3b.
Baseline and perioperative characteristics were comparable between groups (all P>0.01). Overall complication rates were 19.5% and 22.7% (P=0.12), respectively; major complications occurred in 4.9% and 9.1% (P=0.6). Group A exhibited more advanced tumor stage at index NSS (P=0.001). Clear cell renal cell carcinoma predominated in Group B (P<0.001). At a median follow-up of 51 months, OS, CSS, and renal function endpoints were similar (all P>0.3).
Hilar control technique did not significantly influence outcomes following rMIPN. Within the demanding scenario of solitary ipsilateral recurrence, surgical judgment and tailored planning remain essential to preserve function while maintaining oncologic safety at long-term follow-up.
Minerva urology and nephrology. 2025 Oct [Epub]
Umberto Anceschi, Daniele Amparore, Francesco Prata, Rocco S Flammia, Eugenio Bologna, Aldo Brassetti, Leslie C Licari, Flavia Proietti, Alfredo M Bove, Gabriele Tuderti, Mariaconsiglia Ferriero, Riccardo Mastroianni, Salvatore Guaglianone, Mariavittoria Vescovo, Rocco Papalia, Cristian Fiori, Costantino Leonardo, Francesco Porpiglia, Giuseppe Simone
Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy - ., Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy., Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy., Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy., Operative Research Unit of Anatomical Pathology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.