Partial versus radical nephrectomy for complex renal mass: multicenter comparative analysis of functional outcomes...

Area of Science:

• Nephrology
• Urology
• Oncology

Background:

• The utility of partial nephrectomy (PN) for complex renal masses (CRM) remains debated.
• This study investigates the impact of surgical modality on postoperative renal function in CRM patients.

Purpose of the Study:

• To determine the impact of surgical modality (PN vs. radical nephrectomy [RN]) on postoperative renal functional outcomes for complex renal masses (CRM).

Main Methods:

• Retrospective analysis of a multicenter registry (ROSULA) including 969 patients with CRM (RENAL Score 10-12).
• Primary outcome: de-novo estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m².
• Secondary outcomes: de-novo eGFR <60 mL/min/1.73 m², ΔeGFR; analyzed using Cox regression and linear regression; 5-year freedom from de-novo eGFR assessed with Kaplan-Meier analysis.

Main Results:

• Radical nephrectomy (RN) was associated with increased risk for de-novo eGFR <60 (HR=2.57) and <45 (HR=2.39) compared to PN.
• RN was linked to a greater decline in eGFR (ΔeGFR = -10.89).
• Kaplan-Meier analysis showed significantly worse 5-year freedom from de-novo eGFR <60 (33% vs. 71%) and <45 (65% vs. 79%) for RN patients.

Conclusions:

• Partial nephrectomy (PN) provides significant renal functional benefits for selected complex renal mass (CRM) patients compared to radical nephrectomy (RN).
• PN can be considered for CRM when technically feasible, without a substantial increase in major complications.
• Surgical modality choice is critical for preserving renal function in CRM management.