Redo partial or radical nephrectomy for solitary renal recurrence after previous nephron-sparing surgery: Is...

The role of redo minimally invasive partial nephrectomy (rMIPN) for single ipsilateral renal cancer recurrences (RCRs) after prior nephron-sparing surgery (NSS) remains debated. rMIPN offers the potential for renal preservation but carries substantial surgical complexity and perioperative risk. This dual-institutional study compared perioperative, functional, and oncologic outcomes of rMIPN versus redo minimally invasive radical nephrectomy (rMIRN) for solitary ipsilateral RCRs.

From January 2004 to October 2024, 2 prospectively maintained renal cancer databases were queried for patients with solitary, localized RCRs treated with rMIPN (n = 63) or rMIRN (n = 41). Baseline demographics, operative data, renal function, and pathologic findings were retrospectively extracted. Kaplan-Meier analysis tested overall survival (OS), cancer-specific survival (CSS), and progression to stage ≥ 3b chronic kidney disease (CKD), with log-rank test comparisons.

Baseline demographics and tumor characteristics were similar between groups. rMIPN was associated with longer hospital stay (median 3 vs. 2 days), higher complication rates (22.2% vs. 4.9%), and greater transfusion requirements (7.9% vs. 0%; all P < 0.05). At a median follow-up of 47.5 months [IQR 22.2-75], OS, CSS, and CKD progression did not differ significantly between rMIPN and rMIRN (all P > 0.05).

rMIPN provides oncologic and functional outcomes comparable to rMIRN but at the cost of higher perioperative morbidity. Surgical selection should be individualized, weighing the potential benefits of nephron preservation against the higher surgical risks.