Nephron sparing surgery (NSS) in single kidneys: perioperative, functional and oncological outcomes
BAUS ePoster online library. Rintoul-hoad S.
Jun 27, 2018; 211384
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Ms. Sophie Rintoul-hoad
Ms. Sophie Rintoul-hoad
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Introduction: A mass in a single kidney is the classic imperative indication for NSS but questions remain as to how often the twin goals of long term cancer control and freedom from dialysis are achieved.

Methods: Retrospective analysis of open NSS in single kidneys in a single centre (2000-2017). Outcomes addressed: technical success; dialysis; cancer recurrence and mortality. Median follow-up 3years.

Results: 89 patients. Median age 63years. Female 31%. Median pre-operative eGFR: 60 (26-108). Median tumour size: 50mm(15- 110mm). Median PADUA score: 11 (6A-14A). 27% multiple tumours. 7% VHL. Reason for single kidney: cancer nephrectomy 49/89 (55%); benign nephrectomy 17/89 (19%); congenital 23/89 (26%) including horseshoe (n=10); transplant kidney (n=2). NSS successful in 86/89 (97%). Complications ≥Clavien 3: 27/86 (31%); including secondary haemorrhage: n=7 (8%); urine leak: n=7 (8%). Overall survival 69/86 (80%). 75/86 (87%) malignant histology; 21/75 (28%) ≥T2. Cancer-specific survival 65/75 (80%). 6/75 developed local recurrence; 3/6 had positive margin
15/75 developed metastases. Of these: 8/15 had multiple tumours; 5/15 ≥T3 disease. 7/15 had undergone contralateral RCC nephrectomy <18 months previously. 10/15 died from metastatic RCC, 80/86 (93%) patients are dialysis-free. 12/86 dialysed post-op; Risk factors: PADUA>11; multiple tumours; ≥Clavien 3b complication; 1/12 remained dialysis-dependent. 5/86 required late dialysis; 4/5 anephric from treatment of intra-renal recurrence.

Conclusion: NSS for complex tumours in single kidneys is challenging but worthwhile with excellent cancer-specific and dialysis-free survival. The strongest risk factor for long-term dialysis is intra-renal recurrence requiring treatment; and for metastatic disease is multiple tumours or recent contralateral cancer nephrectomy.
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