de Souza Julia Chequer, Vangaveti Venkat, Biros Erik, Mallett Andrew J
Townsville Hospital and Health Service, Douglas, QLD, 4814, Australia.
College of Medicine and Dentistry, James Cook University, Douglas, QLD, 4814, Australia.
J Nephrol. 2025 Jan 7. doi: 10.1007/s40620-024-02173-6.
Renal cell carcinoma (RCC) is a common malignancy, and nephrectomy is the mainstay of treatment for non-metastatic disease. The choice of surgery depends on the risks of oncologic recurrence, kidney function decline, and perioperative complications. This study aimed to identify factors associated with adverse post-operative outcomes in RCC patients undergoing nephrectomy at Townsville University Hospital (TUH).
This was a retrospective, quality assessment study of all adult patients undergoing either open or laparoscopic, partial, or radical nephrectomy for suspected RCC at TUH between January 1, 2016, and December 31, 2020. Patients were identified from the Queensland Health Admitted Data Collection, with a median follow-up time of 39 months post-operatively.
Sixty patients were included; 71.7% underwent radical nephrectomy, and 63.3% were treated with a laparoscopic approach. Adverse kidney function outcomes were identified in 76.7% of patients. In the first 30 days post-nephrectomy, the reduction in estimated glomerular filtration rate (eGFR) in the radical nephrectomy group was more than double that in the partial nephrectomy group (p < 0.001). The rise in average serum creatinine post-radical nephrectomy was more than six times that post-partial nephrectomy (p = 0.001). This discrepancy in kidney function persisted up to three years post-operatively. No significant differences in RCC recurrence, post-operative cardiovascular events, or mortality were observed between partial nephrectomy and radical nephrectomy (p = 0.665, p = 1.00, p = 0.420).
The balance strongly favours partial nephrectomy despite its underutilisation for patients undergoing nephrectomy for suspected non-metastatic RCC at TUH. Urology teams should weigh the factors favouring radical nephrectomy against the risks of nearly universal renal function decline in this group.
肾细胞癌（RCC）是一种常见的恶性肿瘤，肾切除术是治疗非转移性疾病的主要方法。手术方式的选择取决于肿瘤复发风险、肾功能下降以及围手术期并发症。本研究旨在确定汤斯维尔大学医院（TUH）接受肾切除术的RCC患者术后不良结局的相关因素。
这是一项对2016年1月1日至2020年12月31日期间在TUH因疑似RCC接受开放或腹腔镜、部分或根治性肾切除术的所有成年患者进行的回顾性质量评估研究。患者通过昆士兰卫生入院数据收集系统识别，术后中位随访时间为39个月。
纳入60例患者；71.7%接受根治性肾切除术，63.3%采用腹腔镜手术。76.7%的患者出现不良肾功能结局。在肾切除术后的前30天，根治性肾切除术组估计肾小球滤过率（eGFR）的下降幅度是部分肾切除术组的两倍多（p < 0.001）。根治性肾切除术后平均血清肌酐的升高幅度是部分肾切除术后的六倍多（p = 0.001）。这种肾功能差异在术后持续长达三年。部分肾切除术和根治性肾切除术在RCC复发、术后心血管事件或死亡率方面未观察到显著差异（p = 0.665，p = 1.00，p = 0.420）。
尽管在TUH因疑似非转移性RCC接受肾切除术的患者中部分肾切除术使用不足，但权衡利弊后强烈支持部分肾切除术。泌尿外科团队应权衡支持根治性肾切除术的因素与该组几乎普遍存在的肾功能下降风险。
