BACKGROUND When local recurrence of renal cell carcinoma (RCC) occurs after nephron-sparing surgery (NSS) on the ipsilateral side, some surgeons hesitate to perform reoperative surgery because of possible difficulties. We aimed to evaluate the clinical outcomes of repeat partial nephrectomy (RePN) compared with those of initial partial nephrectomy (iPN) for RCC of a solitary kidney. METHODS Until September 2017, 1671 patients with renal tumors underwent NSS. Of these, 79 patients who underwent NSS for sporadic RCC of a solitary kidney were included. Parameters were compared using the Mann-Whitney U, Pearson Chi-square, and Fisher exact tests. RESULTS Eleven patients underwent RePN and 68 underwent iPN. The RePN group had a relatively smaller tumor size (p = 0.0432), longer operative time (p = 0.0432), and higher estimated blood loss (p = 0.0002) than the iPN group. No significant differences in the other clinical factors were found between the groups. The rates of perioperative complications greater than Clavien-Dindo grade II were 18.2% and 17.6% in the RePN group and iPN group, respectively. The mean decreasing rate of estimated glomerular filtration rate was not different between the groups at 3 and 6 months postoperatively. No significant differences were found in hemodialysis-free survival (p = 0.7392) and intrarenal recurrence-free survival (p = 0.4924) between the groups. CONCLUSIONS The clinical outcomes of RePN were not significantly different compared with those of iPN for patients with sporadic RCC of a solitary kidney. RePN is technically feasible with acceptable complication and local recurrence rates with better postoperative kidney function.

中文翻译：

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与孤立肾初始肾部分切除术相比，重复肾部分切除术的临床结果。

背景当同侧保留肾单位手术（NSS）后发生肾细胞癌（RCC）局部复发时，一些外科医生因可能存在的困难而不愿进行再次手术。我们旨在评估重复肾部分切除术 (RePN) 与初始肾部分切除术 (iPN) 对孤立肾 RCC 的临床结果。方法 截至 2017 年 9 月，1671 例肾肿瘤患者接受了 NSS。其中，包括 79 名因孤立肾的散发性 RCC 接受 NSS 的患者。使用 Mann-Whitney U、Pearson 卡方和 Fisher 精确检验比较参数。结果 11 名患者接受了 RePN，68 名患者接受了 iPN。RePN 组具有相对较小的肿瘤大小 (p = 0.0432)、更长的手术时间 (p = 0.0432) 和更高的估计失血量 (p = 0. 0002) 比 iPN 组。组间其他临床因素无显着差异。RePN 组和 iPN 组中大于 Clavien-Dindo Ⅱ级的围手术期并发症发生率分别为 18.2% 和 17.6%。术后 3 个月和 6 个月时，估计肾小球滤过率的平均下降率在各组之间没有差异。组间无血液透析生存率 (p = 0.7392) 和无肾内复发生存率 (p = 0.4924) 无显着差异。结论 对于散发性孤立肾 RCC 患者，RePN 的临床结果与 iPN 的临床结果没有显着差异。RePN 在技术上可行，并发症可接受，局部复发率高，术后肾功能更好。组间其他临床因素无显着差异。RePN 组和 iPN 组中大于 Clavien-Dindo Ⅱ级的围手术期并发症发生率分别为 18.2% 和 17.6%。术后 3 个月和 6 个月时，估计肾小球滤过率的平均下降率在各组之间没有差异。组间无血液透析生存率 (p = 0.7392) 和无肾内复发生存率 (p = 0.4924) 无显着差异。结论 对于散发性孤立肾 RCC 患者，RePN 的临床结果与 iPN 的临床结果没有显着差异。RePN 在技术上可行，并发症可接受，局部复发率高，术后肾功能更好。组间其他临床因素无显着差异。RePN 组和 iPN 组中大于 Clavien-Dindo Ⅱ级的围手术期并发症发生率分别为 18.2% 和 17.6%。术后 3 个月和 6 个月时，估计肾小球滤过率的平均下降率在各组之间没有差异。组间无血液透析生存率 (p = 0.7392) 和无肾内复发生存率 (p = 0.4924) 无显着差异。结论 对于散发性孤立肾 RCC 患者，RePN 的临床结果与 iPN 的临床结果没有显着差异。RePN 在技术上可行，并发症可接受，局部复发率高，术后肾功能更好。