Nephron-sparing Techniques Independently Decrease the Risk of Cardiovascular Events Relative to Radical Nephrectomy in Patients with a T1a–T1b Renal Mass and Normal Preoperative Renal Function

The aim of the study was to test the effect of treatment type (nephron sparing surgery vs radical nephrectomy) on the risk of developing cardiovascular event (CVe) after accounting for individual cardiovascular risk. A multi-institutional collaboration including 1331 patients with a clinical T1a-T1b N0 M0 renal mass and normal renal function before surgery (defined as an estimated glomerular filtration rate≥60 ml/min/1.73 m2). We retrospectively colleted data on RN (n=462, 34.7%) or NSS (n=869, 65.3%) between 1987 and 2013. When stratifying for treatment type, the proportion of patients who experienced CVe at 1, 5, and 10 yr was 5.5%, 9.9%, and 20.2% for NSS patients compared to 8.7%, 15.6%, and 25.9%, respectively, for RN patients (p=0.001). In multivariate analyses, patients who underwent NSS showed a significantly lower risk of developing CVe compared with their RN counterparts after accounting for clinical characteristics and cardiovascular profile. Limitations include the retrospective design of the study. The risk of CVe after renal surgery is not negligible. Patients treated with NSS have roughly half the risk of developing CVe relative to their RN counterparts. After accounting for clinical characteristics, comorbidities, and cardiovascular risk at diagnosis, NSS independently decreases the risk of CVe relative to RN.