Partial Versus Radical Nephrectomy: Comparison of Postoperative Complications and Contribution to Mortality

Abstract

Background: Partial nephrectomy is the preferred treatment method for certain kidney tumors owing to its nephron-preserving benefit. We aimed to compare the occurrence and importance of complications after radical (RN) or partial (PN) nephrectomy for localized renal cell carcinoma (RCC) and contribution to patient mortality. Methods: All RCC cases were extracted from the National Surgical Quality Improvement Program between 2005 and 2017. All-cause mortality was the primary endpoint that defined a failure to rescue (FTR) after the occurrences of complications. Propensity score matching (PSM) was performed to adjust for confounding variables between the 2 groups. The exclusion criteria included patients on dialysis, those with distant metastases, and those with concurrent procedures. Null hypotheses were rejected when P-values were < .05. Results: The database included 24,830 patients, with 22,015 in the RN group and 2815 in the PN. After PSM, 2226 patients after PN were matched 1:1 to an equal number of patients who underwent RN. Overall, postoperative complications occurred in 20.5% after RN, more frequent than 15.9% after PN (P < .001). While the mortality rates were similar, patients were more likely to experience blood transfusion and reintubation, as well as longer hospital stay after RN, while they were likely to have more infectious complications, including abdominal abscess, and more likely to return to the operating room after PN. In both groups, cardiac and respiratory complications were associated with FTR, leading to mortality. Excessive bleeding (requiring transfusion) was also a significant cause of death after RN but not after PN. Conclusion: When planning PN or RN, patients should be counseled on the risks of their selective procedure and the potential increased mortality risk with certain complications. These risks should be weighed against the benefit of those cancer surgeries.