Partial nephrectomy for patients with a solitary kidney: the Memorial Sloan‐Kettering experience

Abstract

A careful analysis of 54 patients with a solitary kidney and who had a partial nephrectomy is reported by authors from New York. They found it to be a safe procedure with an acceptable decline in renal function which stabilised during the first year. The requirement for temporary haemodialysis was low. Authors from China report on the use of a retroperitoneoscopic approach to subcapsular nephrectomy in patients with infective or adhesive non‐functioning kidneys. Their results were excellent and they showed this to be an acceptable technique, with minimal trauma and blood loss and a quick recovery. OBJECTIVE To report the experience of partial nephrectomy in patients with a solitary kidney at one institution, with analysis of renal function, complications, oncological efficacy and survival. PATIENTS AND METHODS We identified 54 consecutive patients with a solitary kidney who had a partial nephrectomy between December 1989 and July 2003. Variables examined included patient age and gender, renal function, renal ischaemia time, surgical margin status and complications. Pathological features, e.g. tumour size, histological subtype and tumour stage, were also assessed. Disease‐free probability and overall and cancer‐specific survivals were determined. RESULTS The histological subtype was clear cell in 35 cases (65%), papillary in 10 (19%), oncocytoma in four (7%), chromophobe in two (4%), unclassified in one (2%) and multiple subtypes in two (2%). The median creatinine level before surgery was 14 mg/L, which increased to 16 mg/L 6 months afterward, and at 1 and 2 years after surgery it was 15 mg/L. Two patients developed end‐stage renal disease requiring haemodialysis, one soon after surgery and another 8 years after nephron‐sparing surgery. In all, 26% of patients developed at least one perioperative complication, with acute renal failure and urinary fistula being the most common. At 5 years the overall and cancer‐specific survival, and disease‐free probability were 68%, 88% and 73%, respectively. CONCLUSIONS Partial nephrectomy is safe in patients with a solitary kidney, with an acceptable decline in renal function and low likelihood of requiring temporary or permanent haemodialysis. After an initial decline, renal function appears to stabilize during the first year.