Five to ten year follow-up of open partial nephrectomy in a solitary kidney

Abstract

Purpose

Follow-up of patients with solitary kidney undergoing partial nephrectomy is limited. We evaluated the overall survival (OS), cancer specific survival (CSS) recurrence free survival (RFS), and renal function in patients ≥5 years after open partial nephrectomy (OPN).

Materials and Methods

We performed a retrospective review of the Cleveland Clinic kidney cancer database, including only patients with a solitary kidney having undergone OPN ≥5 years ago (1980-June 2006) with ≥6 months follow-up. Survival and recurrence analyses were calculated by Cox proportional hazards model and reported in Kaplan Meier survival curves. Linear regression analysis was used to assess post-operative renal function.

Results

282 patients fit our inclusion criteria (mean follow-up 175 months) with 233 patients undergoing OPN ≥10 years ago. Actual OS was 78.5% and 59.5% at 5 and 10 years, respectively. Average eGFR in patients ≥5 and ≥10 years from OPN was 35.1.1mL/min/1.73m2 and 34.5 mL/min/1.73m2, respectively, with 89.7% and 89.6% of patients having chronic kidney disease (CKD) stage ≥3. Of patients still alive ≥5 years from surgery, 8 are on intermittent hemodialysis (IHD) with 5 alive ≥10 years from surgery. There were 76 recurrences for a calculated RFS at 5 years of 72% (95% CI 66-879) and at 10 years of 63% (95% CI 57-71%).

Conclusions

OPN provides reliable long term oncologic control at 5 and 10 years in the solitary kidney. Predicted to actual outcomes correspond well. Although a majority of patients have chronic kidney disease postoperatively, it appears stable with minimal progression to dialysis.