Clinical, pathologic, and functional outcomes after nephron-sparing surgery in patients with a solitary kidney: a multicenter experience.
OBJECTIVE
Surgical management of a renal neoplasm in a solitary kidney is a balance between oncologic control and preservation of renal function. We analyzed patients with a renal mass in a solitary kidney undergoing nephron-sparing procedures to determine perioperative, oncologic, and renal functional outcomes.


METHODS
A multicenter study was performed from 12 institutions. All patients with a functional or anatomic solitary kidney who underwent nephron-sparing surgery for one or more renal masses were included. Tumor size, complications, and recurrence rates were recorded. Renal function was assessed with serum creatinine level and estimated glomerular filtration rate.


RESULTS
Ninety-eight patients underwent 105 ablations, and 100 patients underwent partial nephrectomy (PN). Preoperative estimated glomerular filtration rate (eGFR) was similar between the groups. Tumors managed with PN were significantly larger than those managed with ablation (P<0.001). Ablations were associated with a lower overall complication rate (9.5% vs 24%, P=0.01) and higher local recurrence rate (6.7% vs 3%, P=0.04). Eighty-four patients had a preoperative eGFR ≥60 mL/min/1.73 m(2). Among these patients, 19 (23%) fell below this threshold after 3 months and 15 (18%) at 12 months. Postoperatively, there was no significant difference in eGFR between the groups.


CONCLUSIONS
Extirpation and ablation are both reasonable options for treatment. Ablation is more minimally invasive, albeit with higher recurrence rates compared with PN. Postoperative renal function is similar in both groups and is not affected by surgical approach.
New York University School of Medicine, New York, NY, USA.
Adam C
AC
Mues
Ruslan
R
Korets
Joseph A
JA
Graversen
Ketan K
KK
Badani
Vincent G
VG
Bird
Sara L
SL
Best
Jeffrey A
JA
Cadeddu
Ralph V
RV
Clayman
Elspeth
E
McDougall
Kurdo
K
Barwari
Pilar
P
Laguna
Jean
J
de la Rosette
Louis
L
Kavoussi
Zhamshid
Z
Okhunov
Ravi
R
Munver
Sutchin R
SR
Patel
Stephen
S
Nakada
Matvey
M
Tsivian
Thomas J
TJ
Polascik
Arieh
A
Shalhav
W Bruce
WB
Shingleton
Emilie K
EK
Johnson
J Stuart
JS
Wolf
Jaime
J
Landman
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology