Partial nephrectomy is associated with a lower risk of early-stage chronic kidney disease (CKD) and overall cardiovascular events, compared with radical nephrectomy, in patients with localized renal cell carcinoma (RCC), according to research published in Urologic Oncology.
Investigators found that partial nephrectomy is associated with a lower risk of new-onset postoperative CKD but not advanced CKD or end-stage renal disease. Partial nephrectomy was also associated with a reduction in composite cardiovascular events but not individual cardiovascular events or cardiovascular mortality.
The investigators conducted a systematic review of 31 studies involving 51,866 patients reporting kidney functional outcomes and 11 studies involving 101,678 patients reporting cardiovascular outcomes.
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The mean preoperative estimated glomerular filtration rate (eGFR) was similar between patients undergoing partial nephrectomy and radical nephrectomy — 78.5 and 77.6 mL/min/1.72 m2, respectively.
Compared with partial nephrectomy, radical nephrectomy was associated with a 3.4-fold increased risk of a postoperative eGFR less than 60 mL/min/1.73 m2 and a 4.7-fold increased risk of a postoperative eGFR less than 45 mL/min/1.73 m2. The investigators found no increased risk of a postoperative eGFR less than 30 or less than 15 mL/min/1.73 m2.
The partial nephrectomy group also had a 19% lower risk of composite cardiovascular events compared with the radical nephrectomy group. However, the rates of new-onset or worsening hypertension, myocardial infarction, and cardiovascular mortality did not differ between groups.
The protective effect of partial nephrectomy on functional renal parenchyma may depend on patients’ baseline kidney function and comorbidities, the investigators suggested.
“With the widespread acceptance of PN [partial nephrectomy], it is of paramount importance to recognize that RN [radical nephrectomy] still plays a key role in the surgical treatment of RCC,” the investigators wrote. “The decision of PN versus RN should be individualized.”
The investigators were unable to fully adjust for confounders, such as type of surgical approach (open, laparoscopic, or robotic), warm and cold ischemia times, American Society of Anesthesiology classification status, performance status, and Charlson Comorbidity Index.
Reference
Ochoa-Arvizo M, García-Campa M, Santos-Santillana KM, et al. Renal functional and cardiovascular outcomes of partial nephrectomy versus radical nephrectomy for renal tumors: A systematic review and meta-analysis. Urol Oncol. Published online January 13, 2023. doi:10.1016/j.urolonc.2022.11.024
This article originally appeared on Renal and Urology News
