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Non-clamping Partial Nephrectomy after Previous Partial Nephrectomy for Tumors involving a Solitary Kidney
John E. Humphrey, MD1, Matthew F. Wszolek, MD2, Patrick A. Kenney, MD2, John L. Griffin, PhD3, John A. Libertino, MD1.
1Lahey Clinic, Burlington, MA, USA, 2MD Anderson Cancer Center, Houston, TX, USA, 3Tufts Clinical and Translational Science Institute, Boston, MA, USA.
BACKGROUND: To compare outcomes of non-clamping partial nephrectomy (PN) after previous PN to initial non-clamping PN.
METHODS: Between 1990 and 2009, 75 PNs were performed on solitary functional kidneys utilizing a non-hilar clamping technique. Retrospective analysis included patient demographics, operative data, complications, oncological outcomes and estimated glomerular filtration rate (GFR). Local recurrence (LR) was defined as any recurrent tumor in the renal remnant regardless of location. Preoperative GFR was compared to Early GFR (lowest GFR 7-100 days postoperatively) and Late GFR (101-365 days postoperatively). Kaplan-Meier estimator was utilized to compare renal cell carcinoma (RCC) specific survival and non-RCC-related survival.
RESULTS: 12 patients underwent previous ipsilateral PN and 63 patients did not have previous PN. Median follow-up was 50 months. There was no difference in tumor size, number of lesions resected, or tumor location between the two groups. Repeat PN had a longer operative time (362vs238 minutes, P=0.0014) as well as higher blood loss (3400vs1200mL, P=0.0003). There was no difference in postoperative hemorrhage or urine leak. LR (41.7%vs5.8%, P=0.0007) and positive surgical margins (PSM) (16.7%vs1.9%, P=0.026) were also higher with repeat PN. The repeat PN group had a similar 5-year RCC-specific survival (75.0%vs88.9%, P=0.13). There was no difference in percent change of nadir GFR (7.5%vs7.8%, P=0.93) or percent change of Late GFR (9.9%vs5.7%, P=0.65).
CONCLUSIONS: With the non-clamping technique in solitary kidneys, renal outcomes are similar in patients undergoing initial and repeat PN. Although previous PN was associated with higher PSM and LR, 5-yr RCC specific survival was similar.
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