Worse renal function after radical versus partial nephrectomy

Both radical and partial nephrectomy harbour a non-negligible risk of post-operative chronic kidney disease (CKD) events, even in patients with normal renal function at 5 years post-surgery. However, radical nephrectomy patients tend to compensate the acute loss of renal function derived from the absence of the contralateral kidney with an increase of estimated glomerular filtration rate (eGFR), whereas eGFR in partial nephrectomy patients tends to remain stable over time.

CKD represents a major post-operative long-term complication in renal surgery for renal cell cancer (RCC). This is the case both for radical and partial nephrectomy and despite major advances in surgical techniques. Whether the renal hyperfiltration mechanism after an acute loss of nephron mass could promote a compensatory process over time in oncological patients is still under debate. Therefore, a retrospective study by Prof. Francesco Trevisani (IRCCS Ospedale San Raffaele, Milan, Italy) and colleagues compared the eGFR decay at different time points in patients who underwent radical (n=153) or partial nephrectomy (n=118). eGFR was evaluated prior to surgery, at hospital dismissal, and at 6, 12, 24, 36, 48, and 60 months of follow-up. Included patients had normal renal function at baseline.

Median basal eGFR was 92.3 mL/min/1.73m² for radical nephrectomy and 95.4 mL/min/1.73m² for partial nephrectomy (P=0.01). Most patients were men, with a men-women ratio of 3.2 for radical nephrectomy and 1.8 for partial nephrectomy (P=0.04). CKD class differed between radical nephrectomy (class I in 64% and class II in 36%) and partial nephrectomy (class I in 76% and class II in 24%; P=0.03). The results demonstrated that eGFR decreased significantly more in the radical nephrectomy group versus the partial nephrectomy group (P<0.001 for all timepoints), but that the radical nephrectomy patients tend to improve their eGFR over time.

A prospective comparison multicentre study with living kidney donors is ongoing.

1. Trevisani F. Renal functional outcomes at 5 years from radical and partial nephrectomies in normal renal function patients: An untold story of failed hyperfiltrations. P0623, EAU21 Virtual, 8–12 July 2021.

 

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Posted on 31 August 202117 May 2024