Advantages of Organ-Sparing Treatment Approaches in Metastatic Kidney Cancer

PURPOSE:This study analyzed oncological outcomes of patients with metastatic clear-cell renal cell carcinoma (ccRCC) treated with cytoreductive partial nephrectomy or nephrectomy.METHODS:This prospective non-randomized cohort study included 109 patients with metastatic ccRCC who underwent surgical treatment between 2011 and 2020. Patients were stratified into cytoreductive partial nephrectomy or nephrectomy groups. Survival curves were estimated, and Cox-regression analysis was performed to identify factors affecting potential lethality.RESULTS:The groups differed significantly in terms of T stage and International metastatic RCC database consortium (IMDC) risk groups, but not international society of urological pathology (ISUP) grading. The average blood loss volume was higher in the partial nephrectomy group. In contrast, the duration of post-operative stay, complication rate; and 30-day hospital readmission rate were similar between two groups. There was a significant difference in overall survival in favor of the partial nephrectomy group, who had better 7-year survival rates. Standardization based on the clinical complexity of the patients showed that cytoreductive partial nephrectomy was associated with a lower risk of death compared to nephrectomy.CONCLUSION:Partial nephrectomy is a safe method of choice in patients with metastatic ccRCC. Kidney preservation in a metastatic setting can play a role in reducing potential adverse systemic therapy events and in decreasing the risk for concomitant pathology deterioration.