Comparison of partial nephrectomy to radical nephrectomy for non-metastatic cT2 renal tumors: Results from a Canadian Multi-Institutional Collaborative

BACKGROUND AND OBJECTIVE: Reported outcomes of partial nephrectomy (PN) for cT2 renal cell carcinoma (RCC) have been variable. We aimed to examine outcomes of PN, compared to radical nephrectomy (RN) for cT2 RCC. METHODS: Patients captured in the Canadian Kidney Cancer information system who underwent surgery for cT2 RCC between 2011 and 2023 were included. Clear cell, papillary, and chromophobe histologies were included. Multifocal tumors, and hereditary RCC syndromes were excluded. Groups were matched up to 1:4 based on tumor size, histology, grade and necrosis. KEY FINDINGS AND LIMITATIONS: Of 1778 cT2 patients, 60 PN patients were matched to 224 RN patients. Positive surgical margins were 8.6% for PN vs. 2.8% for RN (P = 0.06). Postoperative complications were 18.3% for PN vs. 9.8% for RN (P = 0.07). Pathological upstaging to T3 was similar (21.7% PN vs. 22.3% RN, P = 0.73). There were no statistically significant recurrence or survival outcomes, however there were non-significant trends in local recurrence (HR 2.07, 95%CI 0.86-5.0), cancer specific survival (HR 0.65, 95%CI 0.19-2.16), overall survival (HR 0.66, 95%CI 0.28-1.57) for PN vs. RN. PN better preserved eGFR (-15.5 [IQR 27.7] vs. -24.4 [IQR 21.5], P = 0.026). CONCLUSIONS AND CLINICAL IMPLICATIONS: In a cohort of patients with non-metastatic cT2 RCC, PN has better preservation of renal function and may have a higher rate of perioperative complications and local recurrence. Acknowledging the presence of residual confounding, PN for T2 RCC is safe and provides acceptable oncological outcomes in well-selected patients.