Clinical outcomes of repeat partial nephrectomy compared to initial partial nephrectomy of a solitary kidney

When local recurrence of renal cell carcinoma (RCC) occurs after nephron-sparing surgery (NSS) on the ipsilateral side, some surgeons hesitate to perform reoperative surgery because of possible difficulties. We aimed to evaluate the clinical outcomes of repeat partial nephrectomy (RePN) compared with those of initial partial nephrectomy (iPN) for RCC of a solitary kidney.

Until September 2017, 1671 patients with renal tumors underwent NSS. Of these, 79 patients who underwent NSS for sporadic RCC of a solitary kidney were included. Parameters were compared using the Mann-Whitney U, Pearson Chi-square, and Fisher exact tests.

Eleven patients underwent RePN and 68 underwent iPN. The RePN group had a relatively smaller tumor size (p = 0.0432), longer operative time (p = 0.0432), and higher estimated blood loss (p = 0.0002) than the iPN group. No significant differences in the other clinical factors were found between the groups. The rates of perioperative complications greater than Clavien-Dindo grade II were 18.2% and 17.6% in the RePN group and iPN group, respectively. The mean decreasing rate of estimated glomerular filtration rate was not different between the groups at 3 and 6 months postoperatively. No significant differences were found in hemodialysis-free survival (p = 0.7392) and intrarenal recurrence-free survival (p = 0.4924) between the groups.

The clinical outcomes of RePN were not significantly different compared with those of iPN for patients with sporadic RCC of a solitary kidney. RePN is technically feasible with acceptable complication and local recurrence rates with better postoperative kidney function.