Functional and oncologic outcomes after partial nephrectomy in anatomical solitary kidney

Abstract

Objective To investigate the effect of partial nephrectomy of anatomical solitary kidney on tumor control and renal function preservation. Methods 10 patients with anatomical solitary kidney underwent partial nephrectomy from December 2007 to May 2016, including 6 males and 4 females ranged from 38 to 71 years old with an average of 57 years old. The PADUA score ranged from 6-10, with an average of 7.6. The tumor diameter ranged from 1.0 to 7.4 cm, with an average of 3.2cm. Results 7 cases underwent laparoscopic surgery. 3 cases underwent open surgery. Mean operation time was 168min (ranged 103-217min). Mean blood loss was 135ml (ranged 20-400ml). The renal arteries were blocked in all patients. The ischemia time ranged from 9 to 33min, with an average of 20.6min. The mean estimated glomerular filtration rate at one week after surgery [40.7ml/(min·1.73 m2)] decreased 44.7% compared with pre-operation [73.6 ml/(min·1.73 m2)]. Acute kidney injury developed in 2 patients. One required temporary dialysis. The other improved after conservative treatment. There were no other complications such as urinary fistula and hemorrhage. The pathology analysis confirmed that 2 cases were angiomyolipoma, one case was benign cyst, 6 cases were renal clear cell carcinoma, and one case was multilocular cystic renal cell carcinoma. 4 cases were stage pT1a, one case was stage pT1b, one case was stage pT2a, and one case was stage pT4. Positive margin was found in one case. The average follow-up period was 28.2 months(ranged 3-58months). Only one patient need long-term dialysis 20 months after surgery at the latest follow up. Another patient had local recurrence and ipsilateral adrenal metastasis. Conclusions Satisfactory effect of tumor control and renal function preservation can be achieved by partial nephrectomy in solitary kidney, which prevent or delay the occurrence of hemodialysis effectively. Key words: Solitary kidney; Kidney neoplasms; Partial nephrectomy