Introduction: Partial nephrectomy (PN) is the gold standard for the resection of amenable small renal masses. Some surgeons have adopted tumor enucleation (TE) over the standard margin PN (SPN) technique based on preservation of healthy renal parenchyma by following the tumor pseudocapsule. However, TE may also confer additional advantages due to avoidance of sharp incision including reduction in perioperative and bleeding complications. Therefore, we evaluated the rate of pseudoaneurysms and other complications following TE vs SPN.
Methods: A retrospective cohort study of patients undergoing PN (TE and SPN) between 2008 and 2020 was conducted. Baseline characteristics, comorbidities including chronic kidney disease and Charlson Comorbidity Index (CCI), prior surgical history, tumor size, clinical stage, and RENAL nephrometry score were captured. Clavien-Dindo complications including pseudoaneurysm were compared between the TE and SPN cohorts with univariable and multivariable logistic regression models.
Results: A total of 467 patients were included, 176 (37.7%) receiving TE and 291 (62.3%) SPN. There were no differences in baseline characteristics such as comorbidity, tumor size, clinical stage, or nephrometry score between groups. Conversion rates were similar but Clavien-Dindo complication rates were significantly less likely for TE with 19 (10.8%) compared to SPN with 68 (23.4%) (multivariable OR 2.55 (95%CI 1.45-4.51), p=0.001). Major Clavien-Dindo grade =3 complications were infrequent, but with notably lower rates for TE vs. SPN (2 (1.1%) vs. 22 (7.6%), multivariable OR 8.83 (95%CI 1.84-42.46), p=0.01). Reduction in bleeding complications was a major driver (1.7% vs. 6.2%, p=0.02) with no pseudoaneurysm events following TE compared to 13 following SPN (0.0% vs 2.8%, p=0.004). Need for interventional radiology largely reflected pseudoaneurysm differences (0 (0.0%) TE vs 14 (3.0%) SPN, p=0.003). Readmission occurred less often after TE vs. SPN (3.4% vs. 8.6%, p=0.03).
Conclusions: Patients receiving TE experienced no clinically significant pseudoaneurysm formation and were less likely to have any bleeding complication or major Clavien-Dindo complication postoperatively. TE is a safe option for PN with avoidance of sharp excision optimizing perioperative parameters along with known benefits in renal function. TE may be preferred when minimizing morbidity aligns with patient selection and preferences.
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