In patients with localized renal cell carcinoma (RCC), nephron-sparing partial nephrectomy compared with radical nephrectomy is associated with a lower risk of developing chronic kidney disease (CKD) but not advanced CKD or end-stage kidney disease (ESKD), investigators report. Partial nephrectomy is also associated with a lower risk of cardiovascular events.
Investigators conducted a systematic review of 31 studies involving 51,866 patients reporting kidney functional outcomes and 11 studies involving 101,678 patients reporting cardiovascular outcomes.
Mean preoperative estimated glomerular filtration rate (eGFR) was similar between the groups undergoing partial nephrectomy (PN) and radical nephrectomy (RN): 78.5 vs 77.6 mL/min/1.72 m2. Compared with PN, RN was significantly associated with a 3.4-fold increased risk of a postoperative eGFR less than 60 mL/min/1.73 m2 and a 4.7-fold increased risk of a postoperative eGFR less than 45 mL/min/1.73 m2, Mario Ochoa-Arvizo, of the University of Edinburgh in the United Kingdom, and colleagues reported in Urologic Oncology. The investigators found no increased risk of a postoperative eGFR less than 30 or less than 15 mL/min/1.73 m2.
The PN group also had a significant 19% lower risk for composite cardiovascular events compared with the RN group, the investigators reported. The rates of new-onset or worsening hypertension, myocardial infarction, and cardiovascular mortality did not differ between groups.
The protective effect of PN on functional renal parenchyma may depend on patients’ baseline kidney function and comorbidities, Ochoa-Arvizo and colleagues suggested.
“With the widespread acceptance of PN, it is of paramount importance to recognize that RN still plays a key role in the surgical treatment of RCC,” the investigators wrote. “The decision of PN versus RN should be individualized.”
The investigators were unable to fully adjust for confounders, such as type of surgical approach (open, laparoscopic, or robotic), warm and cold ischemia times, American Society of Anesthesiology classification status, performance status, and Charlson Comorbidity Index.
Ochoa-Arvizo M, García-Campa M, Santos-Santillana KM, et al. Renal functional and cardiovascular outcomes of partial nephrectomy versus radical nephrectomy for renal tumors: a systematic review and meta-analysis. Urol Oncol. Published online January 13, 2023. doi:10.1016/j.urolonc.2022.11.024