Is partial nephrectomy safe and effective in the setting of frail comorbid patients affected by renal cell carcinoma? Insights from the RECORD 2 multicentre prospective study

Clinical data of 4,325 patients undergone kidney surgery were collected at 26 urological Italian Centers from 2013 to 2016.SLE was defined as a≥95% 10y-EM (assessed using the age-adjusted Charlson comorbidity index [CCI]). A multivariable logistic regres-sion for overall postoperative complications, acute kidney injury (AKI), positive surgical margins (SM) andΔestimated glomerular filtration rate (eGFR)≥25% at 2 years from surgery was performed in patients with SLE including clinically relevant variables. Adjustedoutcomes reported as mean (SD) of the 2 groups were generated using separate multivariable logistic regression models and compared.Results:Overall, 559 patients with SLE were selected. Patients had an ASA score≥3 in 58.4% of cases. A clinical T1a, T1b, and T2 stagewas found in 412 (74.5%), 124 (22.4%), and 17 (3.1%) patients. The median PADUA score was 7 (6−8). Surgical and medical postoperativecomplication rates were registered in 14.8% and 6% cases. Postoperative AKI was reported in 27.3% cases, positive surgical margins (PSM)in 9.3% cases. In this subgroup of patients, ASA score, cerebrovascular disease, surgery in low volume centers, and open surgery were inde-pendent predictors of overall complications. ASA and PADUA scores, renal clamping, resection technique and lower eGFR at baseline wereindependent predictors of AKI. PADUA score, open approach and resection technique were independent predictors of PSM. Cardiovasculardisease, hilar clamping, and resection technique were independent predictors of eGFR decrease>25% at 2 years from surgery.Patients with SLE were compared with those with LLE (n= 302). All analyzed parameters at baseline were significantly different among thegroups with the exception of cancer laterality. After adjusting for several clinical variables, the SLE group had a significantly higher risk rate ofadjusted overall postoperative complication rate compared to the LLE group (20.6%§0.36 vs. 9.9%§0.65,P<0.0001), while the overall intra-operative complications (4.1%§0.13 vs. 2.3%§0.23), overall postoperative major complications (3.8%§0.09 vs. 1.9%§0.14) adjusted AKI(24.2%§0.37 vs. 22.6%§0.92), positive surgical margins (8%§0.22 vs. 6.4%§0.49), and 2-year RF loss (13.4%§0.17 vs. 12.4%§0.74).Conclusion:In selected patients with SLE, PN is feasible with an acceptable safety profile that is overall comparable to patients with no LElimitations. While a robotic approach and surgery performed in high volume centers could reduce the risk of complications, an off-clampapproach and a SE surgical technique may decrease the risk of postoperative AKI and of longer term eGFR decrease.Ó2020 Elsevier Inc. All rights reserved