Presentation Authors: Ricardo Alvim*, Nathan Wong, New York, NY, Amy Tin, New Tork, NY, Renato Fonseca, Daniel Sjoberg, Ari Hakimi, Paul Russo, Jonathan Coleman, New York, NY
Introduction: There are conflicting reports suggesting that hilar tumors are associated worse oncologic outcomes and that these patients should undergo radical nephrectomy. Herein, we evaluated our outcomes of patients with hilar tumors or non-hilar tumors managed with either partial nephrectomy (PN) or radical nephrectomy (RN).
Methods: Between 2008-2018, we performed a retrospective review of patients with a solitary renal mass (size < 5cm) who were scheduled to undergo either PN or RN at MSKCC. Patients were stratified based on tumor location (hilar vs non-hilar) and scheduled procedure (PN vs RN). Hilar tumors were defined as those at medial position, abutting the renal artery and/or vein or its segmental branches, identified on pre-operative axial imaging and subsequently confirmed intra-operatively. The Kaplan-Meier method was used to estimate recurrence-free (RFS), cancer-specific (CSS) and overall survival (OS). The log-rank test was used to test for differences between groups
Results: Among the 2022 included patients, 444 had hilar tumors (323 scheduled for PN, 121 RN) and 1578 (all scheduled for PN) had non-hilar tumors. Median follow-up for survivors was 3.4 (IQR 1.4, 6.0) years following surgery. A higher proportion of patients with hilar tumors scheduled to undergo PN were converted to RN compared to non-hilar tumors (5.6 vs 0.7%, difference 4.9%, 95% CI 2.3% 7%, p < 0.0001). Positive margin rates following PN for hilar and non-hilar tumors were similar (5.6 vs 5.1%; p = 0.7). Mean eGFR at 6 months post-operatively was lower in hilar tumors compared to non-hilar (67 vs 74 ml/min/1.73m2; p < 0.0001). Hilar tumors had more grade 2 or higher complications (within 30 days of surgery) compared to non-hilar tumors (13% vs 8.5%; p = 0.017). Among all patients who were scheduled to undergo PN, 28 patients had a recurrence. Compared to non-hilar tumors, hilar tumors had no significant differences in RFS (p = 0.8), CSS (p = 0.4) or OS (p = 0.2). Among patients with hilar tumors, patients who had a planned PN had similar rates of grade 2 or higher complications compared to those with a planned RN (13 vs 10%; p = 0.4). Among those with hilar tumors, patients who were planned to undergo PN had similar RFS (p = 0.2) and CSS (p = 0.4) compared to patients who were planned to undergo RN
Conclusions: PN for hilar tumors < 5cm is safe with a relatively low complication rate and feasible with similar oncologic outcomes as PN for non-hilar tumors, as well as RN for hilar tumors, of similar size. A renal tumor located at the hilum should not discourage urologists from performing a PN