Long-Term Oncological and Functional Outcomes of Partial Nephrectomy in Solitary Kidneys

In this study we assessed the efficacy of nephron-sparing surgery and the changes in renal function after surgery in patients with solitary kidneys.

From January 2000 to January 2015, 50 patients with solitary kidneys underwent partial nephrectomy for renal cancer. In 34 of the patients the contralateral kidneys had been removed previously because of renal tumor. The mean age of the patients was 62 ± 10 years. There were 15 women and 35 men.

The average diameter of the tumors was 35.2 ± 19.5 mm. The mean preoperative aspects and dimensions used for an anatomical classification score was 7.6 ± 0.7. The mean renal ischemia time was 13.8 ± 6.5 minutes. The mean preoperative and the early postoperative glomerular filtration rate (GFR) were 62 ± 21 mL/min/1.73 m(2) and 44 ± 18 mL/min/1.73 m(2) (P = .0001), respectively. The mean GFR values decreased by 29% at 1 and at 3 years, and by 36% at 5 years after surgery. All changes in postoperative GFR levels were significant compared with the preoperative values. The tumor size and the warm ischemia time were risk factors for the long-term renal function. The mean follow-up time was 106 ± 96 months. During this period local recurrence occurred in 1 patient, and distant metastases were diagnosed in 4 cases. The 5-year overall, disease-specific, and recurrence-free survival were 88%, 93%, and 88%, respectively.

Partial nephrectomy provides a good oncological outcome. However, after nephron-sparing surgery most patients develop chronic renal disease, although hemodialysis treatment is rarely necessary. The tumor size and the warm ischemia time showed a close correlation with the long-term renal function.