title: Five to 10-year followup of open partial nephrectomy in a solitary kidney.
abstract: OBJECTIVE
  Followup is limited in patients with a solitary kidney who undergo partial nephrectomy. We evaluated overall, cancer specific and recurrence-free survival, and renal function in patients 5 years or greater after open partial nephrectomy.
  
  
  METHODS
  We retrospectively reviewed the Cleveland Clinic kidney cancer database, including only patients with a solitary kidney treated with open partial nephrectomy 5 or more years ago (from 1980 to June 2006) who had 6 months or more of followup. Survival and recurrence analyses were calculated using a Cox proportional hazards model. Results are shown as Kaplan-Meier survival curves. Linear regression analysis was done to assess postoperative renal function.
  
  
  RESULTS
  A total of 282 patients fit our study inclusion criteria (mean followup 175 months), of whom 233 underwent open partial nephrectomy 10 or more years ago. Actual overall survival was 78.5% and 59.5% at 5 and 10 years, respectively. The average estimated glomerular filtration rate at 5 years or greater and 10 years or greater since open partial nephrectomy was 35.1 and 34.5 ml/minute/1.73 m(2) in 89.7% and 89.6%, respectively, of patients with stage 3 or greater chronic kidney disease. Eight survivors were on intermittent hemodialysis 5 years or more postoperatively, including 5 at 10 years or more. There were 76 recurrences for a calculated 5 and 10-year recurrence-free survival rate of 72% (95% CI 66-879) and 63% (95% CI 57-71), respectively.
  
  
  CONCLUSIONS
  Open partial nephrectomy in the solitary kidney provides reliable long-term oncological control at 5 and 10 years. Predicted and actual outcomes correspond well. Although most patients have chronic kidney disease postoperatively, it appears stable with minimal progression to dialysis.
authors.affiliation: Vanderbilt University, Nashville, Tennessee, USA.
authors.forename: Christina B
authors.initials: CB
authors.lastname: Ching
authors.forename: Brian R
authors.initials: BR
authors.lastname: Lane
authors.forename: Steven C
authors.initials: SC
authors.lastname: Campbell
authors.forename: Jianbo
authors.initials: J
authors.lastname: Li
authors.forename: Amr F
authors.initials: AF
authors.lastname: Fergany
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000601:surgery*; D007677:Kidney Function Tests; D007680:Kidney Neoplasms / Q000601:surgery*; D016014:Linear Models; D008297:Male; D009364:Neoplasm Recurrence, Local; D009392:Nephrectomy / Q000379:methods*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate
keywords: CKD; CSS; EMR; GFR; OPN; OS; RFS; abnormalities; cancer specific survival; carcinoma; chronic kidney disease; eGFR; electronic medical record; estimated GFR; glomerular filtration rate; kidney; mortality; nephrectomy; open partial nephrectomy; overall survival; recurrence-free survival; renal cell