Functional and Oncological Outcomes of Renal Surgery for Hilar Tumors: Informing the Decisions in Risk-Adapted Management

• Published in: Urology (Ridgewood, N.J.) Vol. 157; pp. 174 - 180
• Main Authors: Alvim, Ricardo G., Tin, Amy L., Nogueira, Lucas, Wong, Nathan C., Fonseca, Renato C., Sjoberg, Daniel D., Hakimi, A. Ari, Touijer, Karim A., Russo, Paul, Coleman, Jonathan A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2021
• Subjects: Aged; Clinical Decision-Making; Female; Glomerulosclerosis, Focal Segmental; Humans; Kaplan-Meier Estimate; Kidney - pathology; Kidney Neoplasms - physiopathology; Kidney Neoplasms - surgery; Male; Middle Aged; Nephrectomy - adverse effects; Nephrectomy - methods; Postoperative Complications - etiology; Retrospective Studies; Risk Assessment; Risk Factors; Survival Rate
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2021.07.014

To describe the safety and efficacy of partial nephrectomy (PN) in comparison to radical nephrectomy (RN) for surgically managed renal hilar tumors. We retrospectively reviewed institutional records of patients with a small (<5 cm) solitary renal (hilar or non-hilar) mass who underwent PN or RN between 2008 and 2018. Hilar tumors were defined as those at medial position, abutting the renal vessels. Recurrence-free, cancer-specific, and overall survival were estimated using the Kaplan-Meier method. Of 1,951 eligible patients, 399 had hilar tumors (292 scheduled for PN, 107 RN) and 1,552 had non-hilar tumors (scheduled for PN). We found no significant differences in survival measures between hilar and non-hilar tumors in patients selected for PN. Patients scheduled for PN for hilar tumors had higher rates of ≥grade II postoperative surgical complications compared to patients scheduled to receive PN for non-hilar tumors (13% vs 8.6%; log-rank P = .018) and non-statistically significantly elevated rates of ≥grade II complications compared to patients scheduled for RN for hilar tumors (13% vs 6.5%; difference 6%, 95% CI 0.4%, 13%; log-rank P = .07). PN for hilar and non-hilar renal masses (<5cm) experience comparable oncologic outcomes though increased risk of complications for hilar masses. PN for hilar tumors was associated with better renal function and overall survival with non-statistically elevated risk of grade II or higher complications than RN. A renal tumor located at the hilum should not be a contra-indication for performing PN.