Long-term outcomes after cytoreductive partial nephrectomy for metastatic renal cell carcinoma.

Objectives: To assess treatment outcomes and evaluate patient selection criteria for cytoreductive partial nephrectomy (CRPN) in a unique cohort of metastatic renal cell carcinoma (mRCC) patients. Methods: A retrospective review of mRCC patients who underwent CRPN between 1995 and 2023 at a single institution was performed. Clinical characteristics, perioperative outcomes, longitudinal imaging reports and overall survival data were analysed. Results: Seventy-three patients with mRCC were included. Forty per cent of patients had prior radical nephrectomy, and 44% had prior metastasectomy. The median tumour size was 4 cm (IQR 2.7, 5.5). Median follow-up among patients who survived was 6.7 years (IQR 3.4, 9.6). Median overall survival was 6.1 years (95% CI 4.6 to 7.8). Complications occurred in 22% of patients within 30 days post-surgery. eGFR stabilized at 3 months after surgery, and no patients required dialysis. Larger tumour size was associated with a higher risk of cancer-specific death (HR 1.19, 95% CI 1.07 to 1.31, p < 0.001). Higher pathologic stage and grade were associated with significantly higher risks of cancer-specific death (HR 2.78, 95% CI 0.83 to 9.36, p = 0.10 and HR 1.45, 95% CI 0.64 to 3.29, p = 0.4, respectively). Conclusion: CRPN was performed effectively as a component of integrated medical and surgical management for highly selected mRCC patients. Preservation of renal function in patients with a solitary kidney or with an intact contralateral kidney was achieved with acceptable surgical morbidity and oncologic outcomes.