Surgical Treatment Outcomes for Complex Renal Masses: Insights From a Comprehensive Cohort Study

Background and Objective: Renal cell carcinoma poses significant challenges in balancing oncological control with renal function preservation, especially in complex renal masses. This study aims to determine the factors influencing postoperative renal function in patients undergoing nephrectomy for complex renal tumors, focusing on the impact of surgical approach and patient characteristics. Methods: A retrospective observational cohort study was conducted at a referral center, involving patients who underwent radical or partial nephrectomy between January 2018 and December 2022. Inclusion criteria were histological diagnosis of renal cancer, pathological staging T1b to T3a, Nx, M0, and a R.E.N.A.L. score ≥ 9. A total of 119 patients met the criteria. Data were collected using the RedCap system and analyzed with SPSS version 27, focusing on surgical outcomes and renal function preservation. Key Findings and Limitations: Younger patients (<60 years), with preoperative glomerular filtration rate (GFR) > 60 mL/min/1.73 m 2 , and those undergoing nephron-sparing surgery with ischemia time < 25 minutes, showed better renal function preservation. Partial nephrectomies were associated with superior GFR maintenance compared with radical procedures. Limitations include the retrospective design and incomplete follow-up data, which may affect the generalizability of the findings. Conclusions and Clinical Implications: The study supports the use of nephron-sparing surgeries in suitable patients to optimize renal function preservation without compromising oncological outcomes. These findings suggest a potential shift toward minimally invasive approaches in managing complex renal masses, although further prospective studies are needed to confirm these results.

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