Revista de nefrología y terapéutica

Comparison of Overall Survival after Nephron-Sparing Surgery and Radical Nephrectomy on the Basis of Preoperative Renal Function and Tumor Size

Abstract

Tsuyoshi Yamaguchi*,Takatsugu Okegawa,Eiji Higashihara,Kikuo Nutahara

Objective: To compare the overall survival (OS) between radical nephrectomy (RN) and nephron-sparing surgery (NSS) by preoperative estimated glomerular filtration rate (eGFR) and tumor size. Methods: Patients with cT1 renal tumors (N0M0) treated by RN or NSS between 1994 and 2014 were included. OS was compared by the surgical technique using Kaplan- Meier curves for the whole population. Then, subgroup analyses for OS were performed by the presence (< 60 ml/min/1.73 m2) or absence (≥ 60 ml/min/1.73 m2) of preoperative chronic kidney disease (CKD) and by cT1a and cT1b disease status. Multivariate analysis was also performed. Results: 440 patients were included. There was no significant difference in OS by the surgical technique, including in patients with CKD. However, the group without CKD had a significantly better OS than the group with CKD. Moreover, compared with RN, the use of NSS was associated with a significantly better OS for patients without CKD, including those with cT1a tumors. There were no significant differences when OS was compared by the surgical technique in patients with CKD or cT1b tumors. Multivariate analysis showed that preoperative eGFR and tumor size were independent risk factors in the total population and the group without CKD, respectively. Conclusion: We have shown that NSS can be beneficial for patients with preoperative non-CKD and stage cT1a tumors. RN and NSS produce comparable OS in patients with unfavorable preoperative renal function or tumor size. Further investigation is needed with larger populations.