Comparative analysis of salvage partial nephrectomy versus radical nephrectomy after the failure of initial partial nephrectomy

Jiwei Huang; Ruopeng Su; Cuijian Zhang; Yige Bao; Xiaoyi Hu; Xiongjun Ye; Minfeng Chen; Ping Wang; Jitao Wu; Yueming Wang; Qi Tang; Zhiyang Huang; Bing Zheng; Chancan Li; Jianming Guo; Yiran Huang; Qiang Wei; Zhisong He; Wei Xue

doi:10.1016/j.urolonc.2023.07.010

Comparative analysis of salvage partial nephrectomy versus radical nephrectomy after the failure of initial partial nephrectomy

Urol Oncol. 2023 Oct;41(10):434.e17-434.e25. doi: 10.1016/j.urolonc.2023.07.010. Epub 2023 Aug 9.

Authors

Jiwei Huang¹, Ruopeng Su², Cuijian Zhang³, Yige Bao⁴, Xiaoyi Hu⁵, Xiongjun Ye⁶, Minfeng Chen⁷, Ping Wang⁸, Jitao Wu⁹, Yueming Wang², Qi Tang³, Zhiyang Huang¹⁰, Bing Zheng¹¹, Chancan Li¹², Jianming Guo⁵, Yiran Huang², Qiang Wei⁴, Zhisong He¹³, Wei Xue¹⁴

Affiliations

¹ Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: [email protected].
² Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
³ Department of Urology, First Hospital of Peking University, Institute of Urology, Peking University, National Urological Cancer Center, Xicheng District, Beijing, P. R. China.
⁴ Department of Urology and Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.
⁵ Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.
⁶ Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁷ Department of Urology, Xiangya Hospital, Central South University, Changsha, China.
⁸ Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
⁹ Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China.
¹⁰ Department of Urology, Quanzhou First Hospital affiliated to Fujian Medical University, Quanzhou, China.
¹¹ The Department of Urology, The Second Affiliated Hospital of Nantong University, Nantong, China.
¹² The Department of Urology, AnHui NO.2 Provincial People Hospital, Hefei, China.
¹³ Department of Urology, First Hospital of Peking University, Institute of Urology, Peking University, National Urological Cancer Center, Xicheng District, Beijing, P. R. China. Electronic address: [email protected].
¹⁴ Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: [email protected].

PMID: 37563078
DOI: 10.1016/j.urolonc.2023.07.010

Abstract

Objectives: To compare the oncologic outcomes and renal function discrepancy of salvage partial nephrectomy (sPN) and salvage radical nephrectomy (sRN) after an initial failed PN.

Materials and methods: Retrospective data from multiple centers between 2008 and 2022 were analyzed in this study. Patients who received sPN or sRN after an initial failed PN were identified. Comparative analysis and propensity score matching (PSM) was performed and the RENAL score, tumor size, and pathological T stage at salvage surgery were used to match the 2 groups. Local recurrence-free survival (LRFS) and recurrence-free survival (RFS) were assessed using the Cox proportional hazards model and log-rank tests. Renal function after salvage surgery was assessed using the Wilcoxon rank sum test.

Results: A total of 140 patients who underwent salvage surgery were evaluated, of whom 60 were considered for PSM analysis after matching. At a median follow-up of 27.0 months, LRFS and RFS showed no significant difference between sPN and sRN, either before (LRFS, HR = 0.673 [95% CI: 0.171-2.644], P = 0.610; RFS, HR = 0.744 [95% CI: 0.271-1.344], P = 0.595) or after matching (LRFS, HR = 1.080 [95% CI: 0.067-17.30], P = 0.957; RFS, HR = 1.199 [95% CI: 0.241-5.983], P = 0.822). During long-term follow-up, sPN preserved renal function (after matching, eGFR, 71.4 vs. 54.0, P < 0.001) and prevented eGFR loss (after matching: 6.6% vs. 25.6%, P < 0.001).

Conclusion: Salvage partial nephrectomy offers a better alternative than sRN for recurrence after initial PN, as sPN preserves renal function better while maintaining parallel tumor control and acceptable complication rates.

Keywords: Partial nephrectomy; Radical nephrectomy; Renal cell carcinoma; Renal function; Salvage surgery.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Carcinoma, Renal Cell* / pathology
Humans
Kidney Neoplasms* / pathology
Nephrectomy
Retrospective Studies
Treatment Outcome