Introduction:

Radical nephrectomy (RN) remains a standard of care approach for management of complex and large renal masses with excellent oncological outcomes. While funcitonal decline post-RN is a well documented phenomenon, complete functional recovery post-RN and its impact on survival outcomes is poorly understood. We sought to investigate outcomes of, and identify and characterize factors contributing to, complete functional recovery in RN.

Methods:

We conducted a retrospective multicenter analysis of patients who underwent open or minimally-invasive RN for localized (T1-3N0M0) Renal Cell Carinoma (RCC) who did not have preoperative chronic kidney disease (CKD). Post-RN "complete functional recovery" (CFR) was defined as less than or equal to 10%  decline in eGFR (ΔeGFR) from preoperative baseline eGFR to last follow-up (ΔeGFR≤10%), calculated by CKD-EPI 2021 equation. CKD was defined as eGFR<60 mL/min/1.73m2. Logistic regression was performed to identify factors associated with CFR, and Cox regression multivariable analysis (MVA) was performed to identify factors associated with all-cause mortality (ACM). Kaplan-Meier analysis (KMA) assessed 5-year overall survival (OS) comparing ΔeGFR≤10%, ΔeGFR>10% and ≤50%, and ΔeGFR>50%.

Results:

We analyzed 2584 patients  with preoperative eGFR>60 mL/min/1.73m2. CFR/ΔeGFR≤10%  was observed in 366 (14.2%). ΔeGFR>10% and ≤50% was noted in 1,934 patients (74.8%), and ΔeGFR>50% was noted in 280 patients (10.8%). Younger age (OR=1.03, p<0.001), Asian (OR=2.33, p<0.001), Latin (OR=1.43, p<0.001), chromophobe-RCC (OR=1.22, p=0.008) were predictive CFR. CFR  (HR=0.45, p<0.001) and Asian ethnicity (HR=0.53, p<0.001) were associated with decreased risk of ACM, while increasing age (HR=1.03, p<0.001), tumor size (HR=1.07, p<0.001), and stage (HR=1.54-5.71, p<0.001) were associated with increased ACM. KMA comparing CFR with patients with ΔeGFR>10% and ≤50% and ΔeGFR>50% demonstrated 5-year OS of 78.5%, 47.4%, and 13.3% (p<0.001).

Conclusion:

A small but significant proportion of patients experience CFR post-RN. Preservation of eGFR was associated with improved OS, ACM, while achievement of CFR was more likely to occur in Asian and Latin patients and patients with chromophobe-RCC. Identificaton of patients more likely to achieve CFR may obviate increased risk of complex nephron-sparing procedures in select patients, while achieving good oncological outcomes. Further investigations are needed. 

Funding: N/A