Sidney Kimmel Medical College, Thomas Jefferson University
Introduction: The decision between partial (PN) versus radical nephrectomy (RN) for localized T1b-T2 renal cell carcinoma (RCC) remains unclear, particularly in cases of oncologic equivalence. PN offers nephron-sparing benefits but has increased risk of complications. RN putatively maximizes oncologic benefit with complex tumors. We analyzed a new nephrectomy-specific database from the National Surgical Quality Improvement Program to determine if patient-specific factors may predict perioperative outcomes to facilitate treatment choice for T1b-T2 RCC. Methods: We identified 2,094 localized T1b-T2 RCC patients undergoing nephrectomy from 2019-2020. Variables of interest include surgical procedure and approach, staging, comorbidities, prophylaxis, and 19 specific perioperative complications. 30-day reoperations and readmissions were also captured. Descriptive statistics were compared using Fisher’s exact test and Pearson’s chi-square test. Multivariable logistic regression models were generated to evaluate complication risks following correction for relevant factors. All statistical tests were two-tailed. p<0.05 was considered statistically significant. Results: 816 patients received PN while 1,278 received RN. Reoperation rates were comparable; however, PN patients more commonly experienced 30-day readmissions (7.0% vs. 4.7%, p=0.026), bleeds (9.19% vs. 5.56%, p=0.001), renal failure requiring dialysis (1.23% vs. 0.31%, p=0.013) and urine leak or fistulae (1.10% vs. 0.31%, p=0.025). Rates of infectious, pulmonary, cardiac, and venothromboembolic events were comparable between the PN and RN cohorts. PN remained predictive of all four complications upon multivariable adjustment. Robotic surgery reduced incidence of several complications, readmissions, and reoperations. Several baseline comorbidities were found to increase risk of 11 separate complications, including bleeds and readmissions. Conclusions: This population-based cohort explicates perioperative outcomes following nephrectomy for pT1b-T2 RCC. In cases of oncologic equivalence, the findings may inform surgical decision making using patient-specific factors. Risk stratification may inform management to improve post-operative quality of life (QOL) and RCC outcomes. SOURCE OF Funding: AUA Summer Medical Student Fellowship: Herbert Brendler, MD Research Fund
