Is partial nephrectomy worth performing compared to radical nephrectomy for small, localised renal cortical tumours in geriatric patients?

Abstract

INTRODUCTION This study aimed to evaluate the likelihood of progression to chronic kidney disease (CKD) in a cohort of geriatric Asian patients who underwent either partial nephrectomy (PN) or radical nephrectomy (RN) for localised pT1 kidney tumours. METHODS Geriatric patients aged > 65 years who underwent PN or RN from 2005 to 2014 for localised kidney masses < 7 cm at a single institution were reviewed retrospectively. Preoperative and postoperative estimated glomerular filtration rates (eGFRs) were calculated using the Modification of Diet in Renal Disease Study equation. Clinicopathological data was analysed for new-onset CKD after at least five years of follow-up. Postoperative complications were measured using the modified Clavien classification system. RESULTS Among 67 patients, 36.4% had diabetes mellitus and 80.3% had hypertension. Pre-existing CKD with eGFR ≤ 60 mL/min/1.73 m2 was present in 23.3% of PN and 43.2% of RN patients. RN and PN patients had similar postoperative morbidity. Those who underwent PN had immediate decline followed by gradual improvement of kidney function at six months after surgery. This improvement was sustained even for patients with four years of clinical follow-up. Among patients with normal preoperative kidney function, new-onset CKD after surgery was found in 20.0% and 52.9% of PN and RN patients, respectively (p = 0.007). CONCLUSION In our study, geriatric patients who underwent PN for localised kidney mass < 7 cm had immediate decline but gradual and sustained improvement in kidney function. PN also resulted in less new-onset CKD through a five-year follow-up period.