BACKGROUND: In the evolving landscape of nephron-sparing surgery (NSS), the role of minimally invasive redo partial nephrectomy (rMIPN) for solitary renal cancer recurrence (RCR) remains debated, particularly considering its technical demands and perioperative risks. In this dual-institutional study, we aimed to investigate long-term perioperative, oncologic, and functional outcomes of rMIPN, comparing off-versus on-clamp hilar strategies. METHODS: Two prospectively maintained renal cancer databases were queried for patients undergoing rMIPN for ipsilateral solitary RCR between January 2004 and October 2024. Sixty-three patients were included and stratified by hilar control: off-clamp (Group A, N.=41) versus on-clamp (Group B, N.=22). Baseline, surgical, pathological, and renal functional outcomes were compared. Kaplan-Meier analysis assessed overall survival (OS), cancer-specific survival (CSS), and progression to CKD stage ≥3b. RESULTS: Baseline and perioperative characteristics were comparable between groups (all P>0.01). Overall complication rates were 19.5% and 22.7% (P=0.12), respectively; major complications occurred in 4.9% and 9.1% (P=0.6). Group A exhibited more advanced tumor stage at index NSS (P=0.001). Clear cell renal cell carcinoma predominated in Group B (P<0.001). At a median follow-up of 51 months, OS, CSS, and renal function endpoints were similar (all P>0.3). CONCLUSIONS: Hilar control technique did not significantly influence outcomes following rMIPN. Within the demanding scenario of solitary ipsilateral recurrence, surgical judgment and tailored planning remain essential to preserve function while maintaining oncologic safety at long-term follow-up.
Off- versus on-clamp minimally invasive redo partial nephrectomy for solitary renal cancer recurrence: a dual-institutional exploration of surgical safety and long-term outcomes
Amparore, Daniele;Bologna, Eugenio;Fiori, Cristian;Porpiglia, Francesco;
2025-01-01
Abstract
BACKGROUND: In the evolving landscape of nephron-sparing surgery (NSS), the role of minimally invasive redo partial nephrectomy (rMIPN) for solitary renal cancer recurrence (RCR) remains debated, particularly considering its technical demands and perioperative risks. In this dual-institutional study, we aimed to investigate long-term perioperative, oncologic, and functional outcomes of rMIPN, comparing off-versus on-clamp hilar strategies. METHODS: Two prospectively maintained renal cancer databases were queried for patients undergoing rMIPN for ipsilateral solitary RCR between January 2004 and October 2024. Sixty-three patients were included and stratified by hilar control: off-clamp (Group A, N.=41) versus on-clamp (Group B, N.=22). Baseline, surgical, pathological, and renal functional outcomes were compared. Kaplan-Meier analysis assessed overall survival (OS), cancer-specific survival (CSS), and progression to CKD stage ≥3b. RESULTS: Baseline and perioperative characteristics were comparable between groups (all P>0.01). Overall complication rates were 19.5% and 22.7% (P=0.12), respectively; major complications occurred in 4.9% and 9.1% (P=0.6). Group A exhibited more advanced tumor stage at index NSS (P=0.001). Clear cell renal cell carcinoma predominated in Group B (P<0.001). At a median follow-up of 51 months, OS, CSS, and renal function endpoints were similar (all P>0.3). CONCLUSIONS: Hilar control technique did not significantly influence outcomes following rMIPN. Within the demanding scenario of solitary ipsilateral recurrence, surgical judgment and tailored planning remain essential to preserve function while maintaining oncologic safety at long-term follow-up.
I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
