Analysis of repeat nephron sparing surgery as a treatment option in patients with a solid mass in a renal remnant

We evaluated the safety and oncological efficacy of repeat nephron sparing surgery in a renal remnant.

We identified 18 patients who underwent 22 repeat nephron sparing surgeries at our institution between 1970 and 2003. Data regarding clinical characteristics, pathological characteristics and perioperative complication rates were collected. Using patients as their own controls, data from the initial nephron sparing surgery on a surgically naive kidney (group 1) were compared with data from the repeat nephron sparing surgery (group 2).

A solitary remnant and von Hippel-Lindau disease at the time of repeat nephron sparing surgery were present in 12 (67%) and 7 (39%) patients, respectively. Median preoperative creatinine was 1.2 and 1.4 mg/dl, and median tumor size was 2.0 and 1.9 cm in groups 1 and 2, respectively. The 2002 primary tumor classification was similar between the 2 groups. There were no perioperative deaths in either group. There was at least 1 perioperative complication observed in 7 (39%) patients in group 1 vs 5 (28%) in group 2. Only 1 patient had chronic renal failure after the first procedure, while a second patient had chronic renal failure and 1 had chronic renal insufficiency after the second procedure. Overall and cancer specific survival at 5 years was 71% and 83%, respectively.

Repeat nephron sparing surgery is a safe procedure that results in complication rates similar to those associated with nephron sparing surgery on a surgically naive kidney in carefully selected patients.