A comparison of outcomes for standard and multiplex partial nephrectomy in a solitary kidney: The National Cancer Institute experience

Joseph A. Baiocco, Mark W. Ball, Asha K. Pappajohn, Kareem N. Rayn, Gennady Bratslavsky, Shawna L. Boyle, William M. Linehan, Adam R. Metwalli

Research output: Contribution to journalArticle

Abstract

Objectives: To study the short and intermediate surgical, renal functional, and oncologic outcomes of multiplex partial nephrectomy (mPN)and standard partial nephrectomy (sPN)in the setting of a solitary kidney. Patients and Methods: Review of a prospectively maintained database of patients undergoing solitary kidney partial nephrectomy at our institution was performed. Patients were stratified into 2 cohorts: mPN–where 3 or more renal tumors were resected and sPN–where 1 or 2 tumors were resected. Perioperative, renal functional, and oncological outcomes were compared. Results: Ninety-three patients with a solitary kidney underwent a total of 121 surgical procedures; 43 (35.5%)were sPN and 78 (64.4%)were mPN. The total and major (Clavien Grade III and IV)complication rates between sPN and mPN were similar (57.1% vs. 70.1%, P = 0.2; 31.0% vs. 35.1%, P = 0.3). At 12 months post-op, the percentage of patients with eGFR > 45 was similar in each group (sPN 87.0%, mPN 73.7%; P = 0.2), and long-term hemodialysis rates were 4.7% and 6.4%, respectively. Completion nephrectomy was performed in 2.3% of sPN and 2.6% of mPN. At a median follow-up of 40.1 months, the metastasis rate was 8.6% in the sPN group and 4.1% in the mPN group (P = 0.4). Conclusions: Partial nephrectomy in the setting of a solitary kidney can effectively preserve renal function. The renal functional and oncologic outcomes were similar in sPN and mPN, with low hemodialysis rates and complication rates within the expected range of these operations. Three or more tumors in a solitary kidney should not be a contraindication for nephron sparing surgery.

Original languageEnglish (US)
Pages (from-to)356.e1-356.e7
JournalUrologic Oncology: Seminars and Original Investigations
Volume37
Issue number6
DOIs
StatePublished - Jun 1 2019
Externally publishedYes

Fingerprint

National Cancer Institute (U.S.)
Nephrectomy
Kidney
Renal Dialysis
Neoplasms
Nephrons

Keywords

  • Multifocal kidney tumors
  • Multiplex partial nephrectomy
  • Nephron sparing surgery
  • Partial nephrectomy
  • Renal cell carcinoma
  • Solitary kidney

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

A comparison of outcomes for standard and multiplex partial nephrectomy in a solitary kidney : The National Cancer Institute experience. / Baiocco, Joseph A.; Ball, Mark W.; Pappajohn, Asha K.; Rayn, Kareem N.; Bratslavsky, Gennady; Boyle, Shawna L.; Linehan, William M.; Metwalli, Adam R.

In: Urologic Oncology: Seminars and Original Investigations, Vol. 37, No. 6, 01.06.2019, p. 356.e1-356.e7.

Research output: Contribution to journalArticle

Baiocco, Joseph A. ; Ball, Mark W. ; Pappajohn, Asha K. ; Rayn, Kareem N. ; Bratslavsky, Gennady ; Boyle, Shawna L. ; Linehan, William M. ; Metwalli, Adam R. / A comparison of outcomes for standard and multiplex partial nephrectomy in a solitary kidney : The National Cancer Institute experience. In: Urologic Oncology: Seminars and Original Investigations. 2019 ; Vol. 37, No. 6. pp. 356.e1-356.e7.
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abstract = "Objectives: To study the short and intermediate surgical, renal functional, and oncologic outcomes of multiplex partial nephrectomy (mPN)and standard partial nephrectomy (sPN)in the setting of a solitary kidney. Patients and Methods: Review of a prospectively maintained database of patients undergoing solitary kidney partial nephrectomy at our institution was performed. Patients were stratified into 2 cohorts: mPN–where 3 or more renal tumors were resected and sPN–where 1 or 2 tumors were resected. Perioperative, renal functional, and oncological outcomes were compared. Results: Ninety-three patients with a solitary kidney underwent a total of 121 surgical procedures; 43 (35.5{\%})were sPN and 78 (64.4{\%})were mPN. The total and major (Clavien Grade III and IV)complication rates between sPN and mPN were similar (57.1{\%} vs. 70.1{\%}, P = 0.2; 31.0{\%} vs. 35.1{\%}, P = 0.3). At 12 months post-op, the percentage of patients with eGFR > 45 was similar in each group (sPN 87.0{\%}, mPN 73.7{\%}; P = 0.2), and long-term hemodialysis rates were 4.7{\%} and 6.4{\%}, respectively. Completion nephrectomy was performed in 2.3{\%} of sPN and 2.6{\%} of mPN. At a median follow-up of 40.1 months, the metastasis rate was 8.6{\%} in the sPN group and 4.1{\%} in the mPN group (P = 0.4). Conclusions: Partial nephrectomy in the setting of a solitary kidney can effectively preserve renal function. The renal functional and oncologic outcomes were similar in sPN and mPN, with low hemodialysis rates and complication rates within the expected range of these operations. Three or more tumors in a solitary kidney should not be a contraindication for nephron sparing surgery.",
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T1 - A comparison of outcomes for standard and multiplex partial nephrectomy in a solitary kidney

T2 - The National Cancer Institute experience

AU - Baiocco, Joseph A.

AU - Ball, Mark W.

AU - Pappajohn, Asha K.

AU - Rayn, Kareem N.

AU - Bratslavsky, Gennady

AU - Boyle, Shawna L.

AU - Linehan, William M.

AU - Metwalli, Adam R.

PY - 2019/6/1

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N2 - Objectives: To study the short and intermediate surgical, renal functional, and oncologic outcomes of multiplex partial nephrectomy (mPN)and standard partial nephrectomy (sPN)in the setting of a solitary kidney. Patients and Methods: Review of a prospectively maintained database of patients undergoing solitary kidney partial nephrectomy at our institution was performed. Patients were stratified into 2 cohorts: mPN–where 3 or more renal tumors were resected and sPN–where 1 or 2 tumors were resected. Perioperative, renal functional, and oncological outcomes were compared. Results: Ninety-three patients with a solitary kidney underwent a total of 121 surgical procedures; 43 (35.5%)were sPN and 78 (64.4%)were mPN. The total and major (Clavien Grade III and IV)complication rates between sPN and mPN were similar (57.1% vs. 70.1%, P = 0.2; 31.0% vs. 35.1%, P = 0.3). At 12 months post-op, the percentage of patients with eGFR > 45 was similar in each group (sPN 87.0%, mPN 73.7%; P = 0.2), and long-term hemodialysis rates were 4.7% and 6.4%, respectively. Completion nephrectomy was performed in 2.3% of sPN and 2.6% of mPN. At a median follow-up of 40.1 months, the metastasis rate was 8.6% in the sPN group and 4.1% in the mPN group (P = 0.4). Conclusions: Partial nephrectomy in the setting of a solitary kidney can effectively preserve renal function. The renal functional and oncologic outcomes were similar in sPN and mPN, with low hemodialysis rates and complication rates within the expected range of these operations. Three or more tumors in a solitary kidney should not be a contraindication for nephron sparing surgery.

AB - Objectives: To study the short and intermediate surgical, renal functional, and oncologic outcomes of multiplex partial nephrectomy (mPN)and standard partial nephrectomy (sPN)in the setting of a solitary kidney. Patients and Methods: Review of a prospectively maintained database of patients undergoing solitary kidney partial nephrectomy at our institution was performed. Patients were stratified into 2 cohorts: mPN–where 3 or more renal tumors were resected and sPN–where 1 or 2 tumors were resected. Perioperative, renal functional, and oncological outcomes were compared. Results: Ninety-three patients with a solitary kidney underwent a total of 121 surgical procedures; 43 (35.5%)were sPN and 78 (64.4%)were mPN. The total and major (Clavien Grade III and IV)complication rates between sPN and mPN were similar (57.1% vs. 70.1%, P = 0.2; 31.0% vs. 35.1%, P = 0.3). At 12 months post-op, the percentage of patients with eGFR > 45 was similar in each group (sPN 87.0%, mPN 73.7%; P = 0.2), and long-term hemodialysis rates were 4.7% and 6.4%, respectively. Completion nephrectomy was performed in 2.3% of sPN and 2.6% of mPN. At a median follow-up of 40.1 months, the metastasis rate was 8.6% in the sPN group and 4.1% in the mPN group (P = 0.4). Conclusions: Partial nephrectomy in the setting of a solitary kidney can effectively preserve renal function. The renal functional and oncologic outcomes were similar in sPN and mPN, with low hemodialysis rates and complication rates within the expected range of these operations. Three or more tumors in a solitary kidney should not be a contraindication for nephron sparing surgery.

KW - Multifocal kidney tumors

KW - Multiplex partial nephrectomy

KW - Nephron sparing surgery

KW - Partial nephrectomy

KW - Renal cell carcinoma

KW - Solitary kidney

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