title: Salvage partial nephrectomy for hereditary renal cancer: feasibility and outcomes.
abstract: OBJECTIVE
  Patients with von Hippel-Lindau disease may require repeat partial nephrectomies to avoid the need for renal replacement therapy. We evaluated outcomes in patients who underwent third or fourth partial nephrectomies on the same kidney, which we call salvage partial nephrectomy.
  
  
  METHODS
  We retrospectively reviewed the charts of patients who underwent surgery at the National Cancer Institute from 1999 to 2006. We identified 11 of 13 patients in whom salvage partial nephrectomy was performed. Surgical outcomes were assessed by renal preservation as well as intraoperative and postoperative complications. Functional outcomes were assessed by comparing serum creatinine, 24-hour urine creatinine clearance, and nuclear renal scan before and after salvage partial nephrectomy.
  
  
  RESULTS
  All patients were alive and had no radiographic evidence of metastatic disease at a median followup of 25 months (range 3 to 83). Major perioperative complications occurred in 6 of 13 patients (46%) and loss of a renal unit occurred in 3 (23%). None of the patients in whom renal units were preserved required dialysis, although there was an upward trend in serum creatinine and a downward trend in creatinine clearance at postoperative followup (p = 0.07 and 0.08, respectively).
  
  
  CONCLUSIONS
  Although salvage partial nephrectomy is technically demanding and it has a high complication rate, it allows many patients to avoid dialysis. We believe that this experience can be used as a reference for surgeons and patients when considering the risks and benefits of salvage partial nephrectomy.
authors.affiliation: Urologic Oncology Branch and Molecular Imaging Program (PLC), Center for Cancer Research, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892-1107, USA. bratslag@mail.nih.gov
authors.forename: Gennady
authors.initials: G
authors.lastname: Bratslavsky
authors.forename: Jack J
authors.initials: JJ
authors.lastname: Liu
authors.forename: Aaron D
authors.initials: AD
authors.lastname: Johnson
authors.forename: Sunil
authors.initials: S
authors.lastname: Sudarshan
authors.forename: Peter L
authors.initials: PL
authors.lastname: Choyke
authors.forename: W Marston
authors.initials: WM
authors.lastname: Linehan
authors.forename: Peter A
authors.initials: PA
authors.lastname: Pinto
mesh_terms: D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000235:genetics* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome; D006623:von Hippel-Lindau Disease / Q000601:surgery*