Mark T Dawidek, Lina Posada Calderon, Juan Sebastian Arroyave Villada, Burcin A Ucpinar, Lennert Eismann, Stephen W Reese, Marc Ganz, Oguz Akin, Ed Reznik, Jonathan A Coleman, A Ari Hakimi, Paul Russo
{"title":"单肾肿瘤并非都一样:高危病例肾部分切除术的疗效","authors":"Mark T Dawidek, Lina Posada Calderon, Juan Sebastian Arroyave Villada, Burcin A Ucpinar, Lennert Eismann, Stephen W Reese, Marc Ganz, Oguz Akin, Ed Reznik, Jonathan A Coleman, A Ari Hakimi, Paul Russo","doi":"10.1097/UPJ.0000000000000802","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>While partial nephrectomy remains the preferred treatment for tumors in solitary kidneys, there is a broad range of complexity to these cases. This retrospective study refines our understanding of renal and oncologic outcomes in high-risk cases of partial nephrectomy of the solitary kidney (PNSK).</p><p><strong>Materials and methods: </strong>Review of our institutional database identified patients who underwent PNSK between 1990 and 2020. Cases were classified as high-risk PNSK based on having any of the following: clinical stage ≥T3, RENAL nephrometry score ≥10, or multiple tumors suspicious for malignancy.es.</p><p><strong>Results: </strong>Of the 124 cases included, 73 were classified as high-risk PNSK. The rate of high-grade peri-operative complications was 32% among high-risk cases, compared with 12% among low-risk cases. The high-risk group recovered less of their baseline renal function compared to the low-risk group, though this gap narrowed with time, and the respective 5-year end-stage renal disease (ESRD)-free survivals were 89% and 100%. Baseline renal function, multifocal tumors, and intraoperative blood loss were predictors of long-term renal function. The 5-year local recurrence-free survival, cancer-specific survival, and overall survival rates in the high-risk group were 83%, 80%, and 77% respectively.</p><p><strong>Conclusions: </strong>Outcomes of PNSK remain preferrable to ESRD in the highest-risk patients. Keys to optimization are meticulous preservation of normal parenchyma and a bloodless field. Longer ischemia time is tolerable to achieve these goals, though may benefit from the application of renal hypothermia.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"101097UPJ0000000000000802"},"PeriodicalIF":0.8000,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Tumors in Solitary Kidneys Are Not All Equal: Outcomes of Partial Nephrectomy in High-Risk Cases.\",\"authors\":\"Mark T Dawidek, Lina Posada Calderon, Juan Sebastian Arroyave Villada, Burcin A Ucpinar, Lennert Eismann, Stephen W Reese, Marc Ganz, Oguz Akin, Ed Reznik, Jonathan A Coleman, A Ari Hakimi, Paul Russo\",\"doi\":\"10.1097/UPJ.0000000000000802\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>While partial nephrectomy remains the preferred treatment for tumors in solitary kidneys, there is a broad range of complexity to these cases. This retrospective study refines our understanding of renal and oncologic outcomes in high-risk cases of partial nephrectomy of the solitary kidney (PNSK).</p><p><strong>Materials and methods: </strong>Review of our institutional database identified patients who underwent PNSK between 1990 and 2020. Cases were classified as high-risk PNSK based on having any of the following: clinical stage ≥T3, RENAL nephrometry score ≥10, or multiple tumors suspicious for malignancy.es.</p><p><strong>Results: </strong>Of the 124 cases included, 73 were classified as high-risk PNSK. The rate of high-grade peri-operative complications was 32% among high-risk cases, compared with 12% among low-risk cases. The high-risk group recovered less of their baseline renal function compared to the low-risk group, though this gap narrowed with time, and the respective 5-year end-stage renal disease (ESRD)-free survivals were 89% and 100%. Baseline renal function, multifocal tumors, and intraoperative blood loss were predictors of long-term renal function. The 5-year local recurrence-free survival, cancer-specific survival, and overall survival rates in the high-risk group were 83%, 80%, and 77% respectively.</p><p><strong>Conclusions: </strong>Outcomes of PNSK remain preferrable to ESRD in the highest-risk patients. Keys to optimization are meticulous preservation of normal parenchyma and a bloodless field. Longer ischemia time is tolerable to achieve these goals, though may benefit from the application of renal hypothermia.</p>\",\"PeriodicalId\":45220,\"journal\":{\"name\":\"Urology Practice\",\"volume\":\" \",\"pages\":\"101097UPJ0000000000000802\"},\"PeriodicalIF\":0.8000,\"publicationDate\":\"2025-03-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Urology Practice\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1097/UPJ.0000000000000802\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Urology Practice","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/UPJ.0000000000000802","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
Tumors in Solitary Kidneys Are Not All Equal: Outcomes of Partial Nephrectomy in High-Risk Cases.
Purpose: While partial nephrectomy remains the preferred treatment for tumors in solitary kidneys, there is a broad range of complexity to these cases. This retrospective study refines our understanding of renal and oncologic outcomes in high-risk cases of partial nephrectomy of the solitary kidney (PNSK).
Materials and methods: Review of our institutional database identified patients who underwent PNSK between 1990 and 2020. Cases were classified as high-risk PNSK based on having any of the following: clinical stage ≥T3, RENAL nephrometry score ≥10, or multiple tumors suspicious for malignancy.es.
Results: Of the 124 cases included, 73 were classified as high-risk PNSK. The rate of high-grade peri-operative complications was 32% among high-risk cases, compared with 12% among low-risk cases. The high-risk group recovered less of their baseline renal function compared to the low-risk group, though this gap narrowed with time, and the respective 5-year end-stage renal disease (ESRD)-free survivals were 89% and 100%. Baseline renal function, multifocal tumors, and intraoperative blood loss were predictors of long-term renal function. The 5-year local recurrence-free survival, cancer-specific survival, and overall survival rates in the high-risk group were 83%, 80%, and 77% respectively.
Conclusions: Outcomes of PNSK remain preferrable to ESRD in the highest-risk patients. Keys to optimization are meticulous preservation of normal parenchyma and a bloodless field. Longer ischemia time is tolerable to achieve these goals, though may benefit from the application of renal hypothermia.