Open partial nephrectomy for imperative and elective indications comparison of peri-operative data and long-term...

To report the outcome of nephron-sparing surgery (NSS) for renal cell carcinoma (RCC) with elective and imperative indications, with analysis of complications, renal function and long-term oncological follow-up.

We analyzed 91 patients undergoing NSS for RCC, 26 with imperative and 65 with elective indications. Variables analyzed included patient age and gender, comorbidities per patient and preoperative renal function. Pathological features included tumor size, WHO 2002 stage and grade. Peri- and postoperative data included complication and re-intervention rates, tumor recurrence and the mortality rate.

RCC was found in 81.3% of cases in the imperative group and in 73.9% in the elective group. Median tumor size was 3.2 and 2.5 cm (p = 0.02) in the imperative and elective groups, respectively. Operation time was longer in the imperative group (p < 0.01). There was no difference between the two groups regarding intraoperative complication rate (p = 0.37), whereas postoperative complications occurred more frequently in the imperative group (p = 0.02). The median follow-up period was 48 months for both groups. Mean serum creatinine during follow-up was significantly higher in the imperative group (238.4 vs 97.2 Micromol/L). However, no patient required hemodialysis. There was no local recurrence or tumor-specific death in either group.

NSS for RCC is a reasonable treatment option for patients with an imperative indication as it prevents the need for hemodialysis as well as ensuring excellent oncological follow-up. A higher postoperative complication rate has to be balanced against improved quality of life.