Who really benefits from nephron-sparing surgery?

Area of Science:

• Urology
• Nephrology
• Oncology

Background:

• Preoperative renal function significantly impacts postoperative outcomes in patients undergoing surgery for renal masses.
• Chronic kidney disease (CKD) staging is crucial for stratifying surgical risk and predicting renal recovery.
• Understanding the differential impact of nephron-sparing surgery (NSS) versus radical nephrectomy (RN) on renal function is vital for patient management.

Purpose of the Study:

• To evaluate how preoperative kidney function influences renal outcomes after NSS and RN.
• To stratify patients based on CKD stage and surgical approach (NSS vs. RN) to assess renal function.
• To determine the long-term risk of developing significant renal impairment after different surgical interventions for renal masses.

Main Methods:

• Retrospective analysis of 1306 patients who underwent renal surgery for localized renal masses.
• Patients were stratified by preoperative CKD stage (I, II, III) based on estimated glomerular filtration rate (GFR).
• Surgical extent (NSS vs. RN) and development of new-onset GFR <30 or <45 mL/min/1.73 m(2) were analyzed using survival analysis.

Main Results:

• NSS showed a lower annual GFR decline rate in CKD stages I and II but not in stage III.
• Overall, 5.0% and 15.0% of patients developed new-onset GFR <30 and <45 mL/min/1.73 m(2), respectively.
• CKD stage II patients undergoing RN had a significantly higher risk of developing significant renal impairment (GFR <30 or <45 mL/min/1.73 m(2)) compared to NSS.

Conclusions:

• NSS is associated with a reduced rate of GFR decline in patients with preoperative CKD stages I and II compared to RN.
• Only CKD stage II patients demonstrated a statistically significant decreased risk of developing severe renal impairment after NSS.
• Surgical management decisions for renal masses should consider preoperative CKD stage to optimize long-term renal outcomes.