title: Functional and oncologic outcomes after nephron-sparing surgery in a solitary kidney: 10 years of experience.
abstract: OBJECTIVE
  To evaluate functional and oncologic outcomes of partial nephrectomy (PN) in patients with a solitary kidney.
  
  
  METHODS
  A retrospective analysis of patients with a solitary kidney undergoing nephron-sparing surgery between March 2003 and March 2013 was performed. GFR was recorded before the procedure and 3 months after surgery, thus establishing a change (cGFR). Several variables that may influence cGFR were analyzed. Complications are herein described, namely bleeding, fistula, acute renal failure and end-stage renal disease (ESRD). Local recurrence and margin status are also described. Survival rates were calculated using the Kaplan Meier method (2 patients with metastasis at the time of surgery were excluded from the analysis).
  
  
  RESULTS
  Forty-five patients were available for analysis. Median follow-up was 27.56 months (r 3-96). Mean cGFR was-7.12mL/min (SD 2.1). Variables significantly related with lower GFR after surgery were loss of renal mass (p=0.01)) and male gender (p=0.03). Four patients (8.8%) experienced hemorrhage. Nine patients (20%) developed a urinary fistula. Only one patient with bleeding required open surgery. Two patients (4.4%) needed transient dialysis. Three patients (6.6%) developed ESRD. Four patients (8.8%) had positive surgical margins (PSMs) and four patients (88%) had local recurrence (2 of these had PSMs). Five patients (11.1%) died during follow-up. Four patients (8.8%) died because of renal cancer. Estimated 2-year overall survival, disease-free survival and cancer specific survival rates were 88.4% (CI 95% 70.5-96); 87.7% (CI 95% 68.1-96) and 92.4% (CI 95% 75-98), respectively.
  
  
  CONCLUSIONS
  Loss of renal mass and male gender were associated with lower postoperative GFR. Our outcomes were comparable with those in the World literature.
authors.affiliation: Departamento de Urología del Hospital Italiano de Buenos Aires, Argentina.
authors.forename: Jose Ignacio
authors.initials: JI
authors.lastname: Costabel
authors.affiliation: Departamento de Urología del Hospital Italiano de Buenos Aires, Argentina.
authors.forename: Patricio Garcia
authors.initials: PG
authors.lastname: Marchinena
authors.affiliation: Departamento de Urología del Hospital Italiano de Buenos Aires, Argentina.
authors.forename: Federico
authors.initials: F
authors.lastname: Tirapegui
authors.affiliation: Departamento de Urología del Hospital Italiano de Buenos Aires, Argentina.
authors.forename: Augusto
authors.initials: A
authors.lastname: Dantur
authors.affiliation: Departamento de Urología del Hospital Italiano de Buenos Aires, Argentina.
authors.forename: Alberto
authors.initials: A
authors.lastname: Jurado
authors.affiliation: Departamento de Urología del Hospital Italiano de Buenos Aires, Argentina.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Gueglio
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D050377:Cold Ischemia; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods* / Q000401:mortality; D059351:Organ Sparing Treatments; D011183:Postoperative Complications; D011184:Postoperative Period; D011379:Prognosis; D051436:Renal Insufficiency, Chronic; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D015996:Survival Rate; D052096:Warm Ischemia