Completion Nephrectomy Outcomes Following Prior Partial Nephrectomy in Hereditary Kidney Cancer Syndromes.

Von Hippel-Lindau disease was the most common hereditary diagnosis among patients undergoing completion nephrectomy.

• Von Hippel-Lindau disease accounted for 62.1% of cases in the cohort.
• The cohort consisted of 58 patients with hereditary kidney cancer syndromes who underwent completion nephrectomy at the National Institutes of Health between 2000 and 2024.
• All patients had undergone at least one prior ipsilateral partial nephrectomy before completion nephrectomy.

Overall perioperative complications occurred in nearly half of patients undergoing completion nephrectomy.

• Overall complications occurred in 43.1% of patients.
• 24.1% of patients experienced a Clavien-Dindo grade ≥ 3 event, indicating severe complications.
• Perioperative mortality was 6.9%, reflecting a high-risk surgical population.
• Open surgery was performed in 56.9% of cases.

Completion nephrectomy was associated with a clinically meaningful decline in renal function.

• The median preoperative estimated glomerular filtration rate (eGFR) was 72 mL/min/1.73 m².
• The median eGFR declined to 50 mL/min/1.73 m² at the first postoperative clinic visit.
• This represents a decline of 22 mL/min/1.73 m², or approximately 31% reduction from baseline.
• Renal functional decline was identified as a primary outcome of interest alongside perioperative complication rates.

Hereditary kidney cancer syndrome patients requiring completion nephrectomy represent a high-risk surgical population that informs patient counseling and decision-making.

• Hereditary syndromes predispose patients to multifocal, bilateral, and/or recurrent renal tumors requiring repeated interventions over a lifetime.
• Nephron-sparing surgery is the preferred management strategy, but completion nephrectomy is required when tumor burden, declining renal function, surgical complications, or pre-transplant indications necessitate definitive kidney removal.
• Data on outcomes in this specific population were previously limited prior to this prospectively maintained cohort study.
• The study was conducted at the National Institutes of Health over a 24-year period (2000–2024).