Feasibility and outcomes of repeat partial nephrectomy.
OBJECTIVE
Despite the proven efficacy of nephron sparing surgery, patients with hereditary renal cancer remain at risk for tumor recurrence. Management options for recurrent tumors include completion nephrectomy, ablation and repeat partial nephrectomy. We examine the feasibility and outcomes of repeat partial nephrectomy performed on the same renal unit.


METHODS
We retrospectively reviewed the records of 51 attempted repeat partial nephrectomy procedures in 47 patients from 1992 to 2006. Demographic information as well as intraoperative, perioperative and renal functional outcome data were collected. Comparison of preoperative and postoperative renal function was performed using the 2-tailed t test.


RESULTS
Major perioperative complications or reoperations occurred in 10 of 51 (19.6%) cases that included 1 perioperative mortality (1.9%). In cases of successful repeat partial nephrectomy there was a statistically significant increase in postoperative serum creatinine (1.35 vs 1.16 mg/dl, p <0.05), and a significant decrease in creatinine clearance (84.6 vs 95.3 ml per minute, p = 0.05) and renogram split function (52.3% vs 54.8%, p <0.05). Two patients required long-term hemodialysis (3.9%). Of the 51 renal units 10 (19.6%) required subsequent operations for additional local recurrence or de novo tumor formations with a median time to subsequent surgery of 50 months. Of 47 patients 46 are alive at a median followup of 56 months.


CONCLUSIONS
Repeat partial nephrectomy is technically feasible. Although there is a statistically significant decrease in postoperative renal functional studies, most patients retained sufficient function to avoid hemodialysis. Repeat partial nephrectomy may provide acceptable oncological control despite the anticipated development of locally recurrent or de novo tumors.
Johnson
Aaron
A
Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892-1107, USA.
Sudarshan
Sunil
S
Liu
Jack
J
Linehan
W Marston
WM
Pinto
Peter A
PA
Bratslavsky
Gennady
G
D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D009392:Nephrectomy / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome