As the oncological outcome of partial nephrectomy (PN) is comparable with radical nephrectomy (RN) and has better renal function preservation, PN is now the standard treatment for T1a renal cell carcinoma (RCC) and should be considered in T1b whenever feasible according to the European Association of Urology (EAU) guideline. However, limited local data regarding the outcomes of PN are available. This study aims at reporting the perioperative outcomes of PN, minimally invasive versus open, of localized RCC from a Hong Kong institute.

Patients with T1 RCC who underwent partial nephrectomy between January 2019 and December 2023 in Queen Mary Hospital were reviewed. Perioperative outcomes were analyzed using t-test and ANOVA (Analysis of variance).

121 patients (median age 66 years old) were enrolled. 70 patients (57.9%) underwent minimally invasive surgery (Group 1) (56.2% being robotic-assisted surgery and 2.5% being laparoscopic surgery) while 50 (41.3%) had adopted an open surgical approach (Group 2). The average tumour size was 2.36 ± 0.92 cm in group 1 and 3.23 ± 1.19 cm in group 2 (p=<0.001). The minimally invasive partial nephrectomy has a shorter mean operative time (162.92 ± 45.9 minutes vs 187.5 ±43.6 minutes, p=0.004). Also, there is less blood loss (270 ± 248 ml vs 444.64 ± 326.1 ml, p= 0.05) and a shorter postoperative length of stay (3.8 days vs 5 days, p=<0.001) were found in Group 1. The mean ischemic time was 19.1 ± 7.77minutes in group 1 vs 16.6 ±6.56 minutes in group 2, p= 0.13. In general, the complications of PN were low with 13% being Claviden-Dindo Grade I or II (e.g. fever and urinary tract infection) and 0.8% had pseudoaneurysm requiring embolization. Renal function was assessed pre-operatively, upon discharge, at postoperative first and third year. It is noted that for patients with stage 2 chronic kidney disease (CKD) preoperatively, there is around two third of patient remains in stage 2 (CKD) and there is around one third of them have developed to stage 3 CKD upon discharge , at 1-year and 3-year follow-up interval.

Partial nephrectomy for T1 renal cell carcinoma has favorable perioperative outcomes. Minimally invasive approach has less blood loss, shorter length of postoperative stay and preservation of renal function is achieved in the majority of the PN cases with a good safety profile.