Renal functional outcomes after minimally invasive partial nephrectomy, single-surgeon experience

Abstract

Objectives

This study aimed to report the impact of minimally invasive partial nephrectomy (PN) on short- and long-term renal functional outcomes through a single-institution, long-term experience.

Materials and methods

We retrospectively reviewed consecutive patients who underwent retroperitoneal laparoscopic and/or robotic-assisted PN for renal masses by a single surgeon between 2016 and 2025. A multimodal perioperative renal-protective protocol was routinely utilized. Baseline estimated glomerular filtration rate (eGFR) was compared with early and late postoperative eGFR changes surveilled over a 2-year period post-PN. Multivariate regression analysis of multiple variables was performed for the association with change in eGFR at 2-year follow-up.

Results

A total of 281 patients with a mean (standard deviation [SD]) age of 67.70 (±10.05) years were included. Mean (SD) baseline serum creatinine and eGFR were 1.04 (±0.31) mg/dL and 74.08 (±19.28) mL/min, respectively. Mean eGFR showed an early postoperative significant decline to 63.98 ± 19.8 mL/min at 2 weeks, followed by delayed recovery at 6 months (69.23 ± 20.87) and then stabilization through 1- (69.4 ± 19.26) and 2-year (68.15 ± 19.67) follow-up. Multivariate logistic regression analysis identified renal mass size (p < 0.001, odds ratio [OR] = 4.78, 95% confidence interval [CI]: 3.34 to 6.23) and preop eGFR (p < 0.001, OR = 0.13, 95% CI: 0.06 to 0.2) as the independent significant predictors of functional decline at 2-year follow-up, whereas other variables including warm ischaemia time (WIT) were statistically insignificant.

Conclusion

After PN, renal function demonstrates a pattern of early decline followed by substantial recovery over time. Tumour size and preoperative eGFR were the main predictors of late eGFR changes. With proper surgical techniques and perioperative renal-protective strategies, the effect of WIT can be mitigated.