Abstract
Introduction
The American-Urological-Association(AUA) Guidelines for renal cancer(2017) recommend
consideration for radical-nephrectomy(RN) over partial(PN) whenever there is increased
oncologic-risk; and RN should be prioritized if three other criteria are all also met: 1) increased tumor-complexity; 2) no preexisting chronic-kidney-disease/
proteinuria, and 3) normal contralateral kidney that will likely provide estimated
glomerular-filtration-rate (eGFR) >45ml/min/1.73m2 even if RN is performed. Our objective was to assess the complexity of decision-making
about RN/PN and utility of AUA Guidelines statements regarding this issue.
Patients and Methods
Retrospective review of 267 consecutive RN/PN from 2019(100-RN/167-PN). High tumor-complexity
was defined as R.E.N.A.L.≥9. Increased oncologic-risk was defined as tumor >7cm, locally-advanced
or infiltrative-features on imaging, or high-risk pathology on biopsy, if obtained.
New-baseline GFR after RN was estimated using global-GFR, split-renal-functioncontralateral, and presuming 25% renal-functional-compensation.
Results
163 patients(61%) fit scenarios that are well-defined in the Guidelines. Of these,
34 had strong indications for RN, and all had RN. Twelve of 129 patients(9.3%) underwent
RN despite Guidelines generally favoring PN. The remaining 104 patients(39%) did not
fit within situations where the Guidelines provide specific recommendations. In these
patients, RN was often performed despite functional-considerations favoring PN due
to overriding concerns about oncologic-risk and/or tumor-complexity.
Conclusion
Our data demonstrate complexity of decision-making about PN/RN as almost 40% of patients
did not fit well-described AUA Guidelines descriptors. Compliance was generally strong
although occasional overutilization of RN remains a concern in our series, and will
be addressed with additional education. Further studies will be required to assess
the generalizability of our findings in other institutions/settings.
Keywords
Abbreviations:
AUA (American urologic association), BMI (body mass index), CKD (chronic kidney disease), CT (computed tomography), eGFR (estimated glomerular filtration rate), IQR (interquartile range), MAG-3 (mercaptoacetyltriglycine), MRI (magnetic resonance imaging), OR (oncologic risk), PN (partial nephrectomy), RCC (renal cell carcinoma), R.E.N.A.L ((R)adius (tumor size as maximal diameter), (E)xophytic/endophytic properties of tumor, (N)earness of tumor deepest portion to collecting system or sinus, (A)nterior (a)/posterior (p) descriptor, and (L)ocation relative to polar lines), RMB (renal mass biopsy), RN (radical nephrectomy), SRF (split renal function), TC (tumor complexity)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: June 08, 2022
Accepted:
June 5,
2022
Received in revised form:
May 30,
2022
Received:
February 9,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
