Renal functional outcomes after minimally invasive partial nephrectomy, single‐surgeon experience

Objectives This study aimed to report the impact of minimally invasive partial nephrectomy (PN) on short‐ and long‐term renal functional outcomes through a single‐institution, long‐term experience. Materials and methods We retrospectively reviewed consecutive patients who underwent retroperitoneal laparoscopic and/or robotic‐assisted PN for renal masses by a single surgeon between 2016 and 2025. A multimodal perioperative renal‐protective protocol was routinely utilized. Baseline estimated glomerular filtration rate (eGFR) was compared with early and late postoperative eGFR changes surveilled over a 2‐year period post‐PN. Multivariate regression analysis of multiple variables was performed for the association with change in eGFR at 2‐year follow‐up. Results A total of 281 patients with a mean (standard deviation [SD]) age of 67.70 (±10.05) years were included. Mean (SD) baseline serum creatinine and eGFR were 1.04 (±0.31) mg/dL and 74.08 (±19.28) mL/min, respectively. Mean eGFR showed an early postoperative significant decline to 63.98 ± 19.8 mL/min at 2 weeks, followed by delayed recovery at 6 months (69.23 ± 20.87) and then stabilization through 1‐ (69.4 ± 19.26) and 2‐year (68.15 ± 19.67) follow‐up. Multivariate logistic regression analysis identified renal mass size ( p < 0.001, odds ratio [OR] = 4.78, 95% confidence interval [CI]: 3.34 to 6.23) and preop eGFR ( p < 0.001, OR = 0.13, 95% CI: 0.06 to 0.2) as the independent significant predictors of functional decline at 2‐year follow‐up, whereas other variables including warm ischaemia time (WIT) were statistically insignificant. Conclusion After PN, renal function demonstrates a pattern of early decline followed by substantial recovery over time. Tumour size and preoperative eGFR were the main predictors of late eGFR changes. With proper surgical techniques and perioperative renal‐protective strategies, the effect of WIT can be mitigated.