685 Background: Radical Nephrectomy (RN) has been the standard of care for complex and locally advanced renal cell carcinoma (RCC). Efficacy of PN in the setting of pT3a pathologic upstaged disease is controversial. We compared oncologic and functional outcomes of RN and PN in patients with upstaged pT3a RCC. Methods: Multicenter retrospective analysis of patients with cT1−2N0M0 RCC undergoing RN or PN upstaged to pT3a postoperatively. Primary outcome was Overall Survival (OS), with secondary outcomes being Recurrence Free Survival (RFS) and eGFR < 60 at last follow-up. Results: 8185 patients were analyzed (mean follow up 48 months). 945 (11.5%) were upstaged to pT3a [686 (72.6%) RN, 243 (25.7%) PN]. Logistic regression analysis showed that increasing age, decreasing BMI, increasing intraoperative EBL, and positive margin increased the OR of all-cause mortality (all p < 0.05, Table). Kaplan Meier analysis (KMA) revealed 5−year OS for PN cT1→pT3a, RN cT1→pT3a, PN cT2→pT3a, RN cT2→pT3a of 64%, 65.2%, 56.4% and 55.2% respectively (p = 0.059). KMA revealed 5−year RFS for PN cT1→pT3a, RN cT1→pT3a, PN cT2→pT3a, RN cT2→pT3a of 79%, 74%, 70% and 51% respectively (p < 0.001). PN was associated with a decreased risk of GFR < 60 at follow up (39.6% vs. 59.5% for RN, p = 0.008) Conclusions: PN did not adversely affect oncologic outcomes in select patients who are upstaged to pT3a RCC from cT1 or cT2 disease, and may provide renal functional benefit. Improvements with respect to RFS for PN are most likely driven by selection bias. [Table: see text]
Oncological and functional outcomes of salvage renal surgery following failed primary intervention for renal cell carcinoma
