Functional, Oncological and Safety Outcomes of Nephron-Preserving Surgery Compared to Radical Nephrectomy in Patients with Localized Renal Carcinoma with High Anatomical Complexity: A Retrospective Cohort Study Using Propensity Score Matching Method
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BMJ Open. Dec 24, 2021; 11 (12): e051622. doi: 10.1136 / bmjopen-2021-051622.
BACKGROUND: Nephron Sparing Surgery (NSS) is widely applied for small renal masses. However, the indication of SNS in patients with localized renal cell carcinoma (CRC) with high anatomical complexity is controversial. Thus, we compare the functional and oncological results, and the safety of NSS compared to radical nephrectomy (RN) in patients with localized RCC with high anatomical complexity Radius, Exophytic / endophytic, Proximity, Anterior / posterior, Site. (RENAL) score ≥10.
METHODS: We evaluated 575 patients with localized RCC who underwent NSS or RN at our center between January 2013 and December 2018. Demographic characteristics, comorbidities, tumor data, surgical procedure, perioperative data and data survival were recorded. After matching the propensity scores, the variables were compared by paired binary logistic regression. The change in estimated glomerular filtration rate (eGFR) was compared to an analysis of covariance adjusted for baseline. Recurrence and survival were calculated using Kaplan-Meier curves with log-rank tests. P
RESULTS: In the paired group, the NSS showed less loss of eGFR than in the RN group (17.81 ml / min / 1.73 m2 against 28.28 ml / min / 1.73 m2, p
Conclusion: NSS resulted in better preservation of renal function and oncologic outcomes compared to RN, with acceptable complications. These findings could help improve clinical decision making for patients with localized RCC with high anatomical complexity.
TRIAL REGISTRATION NUMBER: ChiCTR2000040652.