Management of high complexity renal masses in partial nephrectomy: A multicenter analysis

Area of Science:

• Urology
• Nephrology
• Oncology

Background:

• Partial nephrectomy (PN) is a standard treatment for renal masses.
• Complex renal tumors, defined by high nephrometry scores, present surgical challenges.
• Evaluating PN outcomes for high-risk tumors is crucial for patient management.

Purpose of the Study:

• To assess the safety and efficacy of PN in patients with high nephrometry score renal tumors (≥10).
• To identify factors associated with achieving trifecta outcomes in these complex cases.

Main Methods:

• A multi-institutional database was used to identify 144 patients with R.E.N.A.L. nephrometry score ≥10 undergoing PN.
• Analysis included baseline demographics, tumor characteristics, and perioperative/pathological outcomes.
• Trifecta achievement (warm ischemia <25 min, no perioperative complications, negative margins) was the primary endpoint.

Main Results:

• Trifecta was achieved in 61.81% of patients.
• Median ischemia time was 20 minutes, with low complication rates (perioperative 17.3%, major 2.34%).
• Pathologic tumor stage was the only factor significantly associated with trifecta achievement (P=0.025).

Conclusions:

• PN is a viable option for complex renal tumors with high nephrometry scores.
• Careful case selection and surgical experience can lead to successful trifecta outcomes.
• This approach supports nephron-sparing surgery even in challenging cases.