Comparison of Laparoscopic Partial Nephrectomy vs. Radical Nephrectomy for Renal Tumors with a Renal Nephrometry Score ≥10: A Propensity Score Matched Analysis

Objective: The aim of this study was to assess the oncologic and functional outcomes associated with laparoscopic partial nephrectomy (LPN) in patients diagnosed with high-complexity renal tumors. Materials and Methods: From November 2009 to October 2018, 399 patients underwent LPN, while 307 patients underwent laparoscopic radical nephrectomy (LRN). Employing propensity score matching to mitigate potential selection bias, individuals were matched on the basis of age, gender, clinical tumor stage, tumor size, baseline renal function, comorbidities, and final tumor pathology. A comparative analysis of functional and oncological outcomes was subsequently conducted across the two groups. Results: After conducting propensity score analysis, a cohort of 39 patients who underwent LPN was meticulously matched with an equivalent number from the LRN group. The LPN group exhibited a postoperative major complication rate of 10.3%. In the year following surgery, the LRN group demonstrated a notably higher relative decline in renal function compared with the LPN group (-26% vs. -11%, p=0.001). Nevertheless, the two groups displayed similar levels of overall survival (94.9% vs. 82.1%, p=0.545) and recurrence-free survival (97.4% vs. 87.2%, p=0.227). Conclusions: Although LPN is linked to heightened postoperative complication risks, it may yield superior functional outcomes and maintain comparable oncological outcomes, particularly within proficient medical institutions, for patients grappling with high-complexity renal tumors.