Presentation Authors: Madhur Nayan*, Olli Saarela, Keith Lawson, Lisa Martin, Maria Komisarenko, Antonio Finelli, Toronto, Canada
Introduction: Surgery remains the mainstay of treatment for localized renal cell carcinoma (RCC). However, there remains uncertainty whether partial nephrectomy is associated with a reduced risk of developing chronic kidney disease or end-stage renal disease compared to radical nephrectomy. Therefore, the objective of this study was to compare renal outcomes in patients undergoing partial or radical nephrectomy for T1a RCC.
Methods: We used administrative databases, several of which have been validated, to perform a population-based study of patients in Ontario, Canada, undergoing a partial or radical nephrectomy for T1a RCC between 1994 and 2014. We excluded patients with more than one nephrectomy or a previous history of chronic kidney disease, diabetes, or hypertension. The outcomes of interest were diagnosis of chronic kidney disease and end-stage renal disease requiring renal replacement therapy, defined as receipt of chronic dialysis or renal transplant. We used Cox proportional hazard models to evaluate the association between partial vs. radical nephrectomy and these outcomes.
Results: We identified 1967 patients that met inclusion criteria, of which 893 (45.5%) underwent partial nephrectomy. Patients undergoing partial nephrectomy were more likely to be younger, have a lower Charlson score, have smaller tumour sizes, and undergo surgery in more recent years. With a median follow-up in those without death of 7.6 years (interquartile range 4.3 - 12.9), 238 and 15 patients developed chronic kidney disease and end-stage renal disease, respectively. Multivariable Cox proportional hazard models found that partial nephrectomy was independently associated with a significantly reduced risk of chronic kidney disease (hazard ratio (HR) 0.16, 95% confidence interval (CI) 0.10 to 0.25). On univariate analysis, partial nephrectomy was not significantly associated with receipt of renal replacement therapy (HR 0.26, 95% CI 0.06 to 1.17).
Conclusions: Our population-based study comparing partial vs. radical nephrectomy for T1a renal cell carcinoma found that partial nephrectomy was associated with significantly reduced risk of chronic kidney disease. However, the need for renal replacement therapy occurred infrequently and there was no significant association with type of surgery.