Can partial nephrectomy preserve renal function and modify survival in comparison with radical nephrectomy?

Area of Science:

• Urology
• Nephrology
• Oncology

Background:

• T1 renal cell carcinoma (RCC) management involves radical nephrectomy (RN) or nephron-sparing surgery (NSS).
• The impact of these surgical approaches on renal function and long-term outcomes requires further investigation.

Purpose of the Study:

• To compare the effects of RN and NSS on renal function, oncological outcomes, and survival rates in patients with T1 RCC.

Main Methods:

• A retrospective analysis of 290 patients with T1 RCC (tumour diameter < 7 cm) undergoing either RN (174 patients) or NSS (116 patients).
• Glomerular filtration rate (GFR) was estimated using the MDRD4 equation.
• Renal function evolution and oncological outcomes were assessed up to 4 years post-surgery.

Main Results:

• RN led to significant renal function impairment compared to NSS (25 vs 7 ml/min/1.73 m² at 6 months), a difference sustained over time.
• Patients undergoing RN had a higher incidence of renal failure.
• Overall mortality was significantly higher in the RN group (p = 0.034), though cancer-specific mortality did not differ significantly (p = 0.079).

Conclusions:

• NSS is the preferred primary treatment for T1 renal cortical tumours when feasible.
• NSS achieves comparable oncological outcomes to RN while preserving renal function.
• Preservation of renal function with NSS may contribute to a lower overall mortality rate.