A clinical audit of adverse post-nephrectomy outcomes in renal cell carcinoma patients at a tertiary hospital in Queensland, Australia.

Background: Renal cell carcinoma (RCC) is a common malignancy, and nephrectomy is the mainstay of treatment for non-metastatic disease. The choice of surgery depends on the risks of oncologic recurrence, kidney function decline, and perioperative complications. This study aimed to identify factors associated with adverse post-operative outcomes in RCC patients undergoing nephrectomy at Townsville University Hospital (TUH).

Methods: This was a retrospective, quality assessment study of all adult patients undergoing either open or laparoscopic, partial, or radical nephrectomy for suspected RCC at TUH between January 1, 2016, and December 31, 2020. Patients were identified from the Queensland Health Admitted Data Collection, with a median follow-up time of 39 months post-operatively.

Results: Sixty patients were included; 71.7% underwent radical nephrectomy, and 63.3% were treated with a laparoscopic approach. Adverse kidney function outcomes were identified in 76.7% of patients. In the first 30 days post-nephrectomy, the reduction in estimated glomerular filtration rate (eGFR) in the radical nephrectomy group was more than double that in the partial nephrectomy group (p < 0.001). The rise in average serum creatinine post-radical nephrectomy was more than six times that post-partial nephrectomy (p = 0.001). This discrepancy in kidney function persisted up to three years post-operatively. No significant differences in RCC recurrence, post-operative cardiovascular events, or mortality were observed between partial nephrectomy and radical nephrectomy (p = 0.665, p = 1.00, p = 0.420).

Conclusions: The balance strongly favours partial nephrectomy despite its underutilisation for patients undergoing nephrectomy for suspected non-metastatic RCC at TUH. Urology teams should weigh the factors favouring radical nephrectomy against the risks of nearly universal renal function decline in this group.