Clinical, pathologic, and functional outcomes after nephron-sparing surgery in patients with a solitary kidney

A multicenter experience

Adam C. Mues, Ruslan Korets, Joseph A. Graversen, Ketan K. Badani, Vincent G. Bird, Sara L. Best, Jeffrey A Cadeddu, Ralph V. Clayman, Elspeth McDougall, Kurdo Barwari, Pilar Laguna, Jean De La Rosette, Louis Kavoussi, Zhamshid Okhunov, Ravi Munver, Sutchin R. Patel, Stephen Nakada, Matvey Tsivian, Thomas J. Polascik, Arieh Shalhav & 4 others W. Bruce Shingleton, Emilie K. Johnson, J. Stuart Wolf, Jaime Landman

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background and Purpose: Surgical management of a renal neoplasm in a solitary kidney is a balance between oncologic control and preservation of renal function. We analyzed patients with a renal mass in a solitary kidney undergoing nephron-sparing procedures to determine perioperative, oncologic, and renal functional outcomes. Patients and Methods: A multicenter study was performed from 12 institutions. All patients with a functional or anatomic solitary kidney who underwent nephron-sparing surgery for one or more renal masses were included. Tumor size, complications, and recurrence rates were recorded. Renal function was assessed with serum creatinine level and estimated glomerular filtration rate. Results: Ninety-eight patients underwent 105 ablations, and 100 patients underwent partial nephrectomy (PN). Preoperative estimated glomerular filtration rate (eGFR) was similar between the groups. Tumors managed with PN were significantly larger than those managed with ablation (P<0.001). Ablations were associated with a lower overall complication rate (9.5% vs 24%, P=0.01) and higher local recurrence rate (6.7% vs 3%, P=0.04). Eighty-four patients had a preoperative eGFR ≥60mL/min/1.73m2. Among these patients, 19 (23%) fell below this threshold after 3 months and 15 (18%) at 12 months. Postoperatively, there was no significant difference in eGFR between the groups. Conclusions: Extirpation and ablation are both reasonable options for treatment. Ablation is more minimally invasive, albeit with higher recurrence rates compared with PN. Postoperative renal function is similar in both groups and is not affected by surgical approach.

Original languageEnglish (US)
Pages (from-to)1361-1366
Number of pages6
JournalJournal of Endourology
Volume26
Issue number10
DOIs
StatePublished - Oct 1 2012

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Nephrons
Kidney
Glomerular Filtration Rate
Nephrectomy
Recurrence
Kidney Neoplasms
Multicenter Studies
Creatinine
Neoplasms
Serum

ASJC Scopus subject areas

  • Urology

Cite this

Mues, A. C., Korets, R., Graversen, J. A., Badani, K. K., Bird, V. G., Best, S. L., ... Landman, J. (2012). Clinical, pathologic, and functional outcomes after nephron-sparing surgery in patients with a solitary kidney: A multicenter experience. Journal of Endourology, 26(10), 1361-1366. https://doi.org/10.1089/end.2012.0114

Clinical, pathologic, and functional outcomes after nephron-sparing surgery in patients with a solitary kidney : A multicenter experience. / Mues, Adam C.; Korets, Ruslan; Graversen, Joseph A.; Badani, Ketan K.; Bird, Vincent G.; Best, Sara L.; Cadeddu, Jeffrey A; Clayman, Ralph V.; McDougall, Elspeth; Barwari, Kurdo; Laguna, Pilar; De La Rosette, Jean; Kavoussi, Louis; Okhunov, Zhamshid; Munver, Ravi; Patel, Sutchin R.; Nakada, Stephen; Tsivian, Matvey; Polascik, Thomas J.; Shalhav, Arieh; Bruce Shingleton, W.; Johnson, Emilie K.; Stuart Wolf, J.; Landman, Jaime.

In: Journal of Endourology, Vol. 26, No. 10, 01.10.2012, p. 1361-1366.

Research output: Contribution to journalArticle

Mues, AC, Korets, R, Graversen, JA, Badani, KK, Bird, VG, Best, SL, Cadeddu, JA, Clayman, RV, McDougall, E, Barwari, K, Laguna, P, De La Rosette, J, Kavoussi, L, Okhunov, Z, Munver, R, Patel, SR, Nakada, S, Tsivian, M, Polascik, TJ, Shalhav, A, Bruce Shingleton, W, Johnson, EK, Stuart Wolf, J & Landman, J 2012, 'Clinical, pathologic, and functional outcomes after nephron-sparing surgery in patients with a solitary kidney: A multicenter experience', Journal of Endourology, vol. 26, no. 10, pp. 1361-1366. https://doi.org/10.1089/end.2012.0114
Mues, Adam C. ; Korets, Ruslan ; Graversen, Joseph A. ; Badani, Ketan K. ; Bird, Vincent G. ; Best, Sara L. ; Cadeddu, Jeffrey A ; Clayman, Ralph V. ; McDougall, Elspeth ; Barwari, Kurdo ; Laguna, Pilar ; De La Rosette, Jean ; Kavoussi, Louis ; Okhunov, Zhamshid ; Munver, Ravi ; Patel, Sutchin R. ; Nakada, Stephen ; Tsivian, Matvey ; Polascik, Thomas J. ; Shalhav, Arieh ; Bruce Shingleton, W. ; Johnson, Emilie K. ; Stuart Wolf, J. ; Landman, Jaime. / Clinical, pathologic, and functional outcomes after nephron-sparing surgery in patients with a solitary kidney : A multicenter experience. In: Journal of Endourology. 2012 ; Vol. 26, No. 10. pp. 1361-1366.
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T1 - Clinical, pathologic, and functional outcomes after nephron-sparing surgery in patients with a solitary kidney

T2 - A multicenter experience

AU - Mues, Adam C.

AU - Korets, Ruslan

AU - Graversen, Joseph A.

AU - Badani, Ketan K.

AU - Bird, Vincent G.

AU - Best, Sara L.

AU - Cadeddu, Jeffrey A

AU - Clayman, Ralph V.

AU - McDougall, Elspeth

AU - Barwari, Kurdo

AU - Laguna, Pilar

AU - De La Rosette, Jean

AU - Kavoussi, Louis

AU - Okhunov, Zhamshid

AU - Munver, Ravi

AU - Patel, Sutchin R.

AU - Nakada, Stephen

AU - Tsivian, Matvey

AU - Polascik, Thomas J.

AU - Shalhav, Arieh

AU - Bruce Shingleton, W.

AU - Johnson, Emilie K.

AU - Stuart Wolf, J.

AU - Landman, Jaime

PY - 2012/10/1

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N2 - Background and Purpose: Surgical management of a renal neoplasm in a solitary kidney is a balance between oncologic control and preservation of renal function. We analyzed patients with a renal mass in a solitary kidney undergoing nephron-sparing procedures to determine perioperative, oncologic, and renal functional outcomes. Patients and Methods: A multicenter study was performed from 12 institutions. All patients with a functional or anatomic solitary kidney who underwent nephron-sparing surgery for one or more renal masses were included. Tumor size, complications, and recurrence rates were recorded. Renal function was assessed with serum creatinine level and estimated glomerular filtration rate. Results: Ninety-eight patients underwent 105 ablations, and 100 patients underwent partial nephrectomy (PN). Preoperative estimated glomerular filtration rate (eGFR) was similar between the groups. Tumors managed with PN were significantly larger than those managed with ablation (P<0.001). Ablations were associated with a lower overall complication rate (9.5% vs 24%, P=0.01) and higher local recurrence rate (6.7% vs 3%, P=0.04). Eighty-four patients had a preoperative eGFR ≥60mL/min/1.73m2. Among these patients, 19 (23%) fell below this threshold after 3 months and 15 (18%) at 12 months. Postoperatively, there was no significant difference in eGFR between the groups. Conclusions: Extirpation and ablation are both reasonable options for treatment. Ablation is more minimally invasive, albeit with higher recurrence rates compared with PN. Postoperative renal function is similar in both groups and is not affected by surgical approach.

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