Delayed partial nephrectomy following complete response to immunotherapy: feasibility and results (UroCCR n°157)

Background: Complete responses to immunotherapy in metastatic kidney cancer have led to a renewed interest in primary-site surgery. The prolonged survival of these patients has prompted consideration for nephron-sparing surgery when technically feasible. Given the surgical difficulties reported in the literature, it is essential to assess the feasibility as well as functional and oncological results of partial nephrectomy (PN) after immunotherapy. Methods: Multicentric retrospective study based on UroCCR database, including all metastatic patients who underwent PN after a complete response to immunotherapy at metastatic sites. Morbidity, renal function, positive margin rate, and oncological outcomes were assessed. Results: Thirteen patients underwent PN after immune checkpoint inhibitor (ICI), between January 2019 and September 2023. Median age at surgery was 64 [50–68]; 84.6% received ICI as first-line treatment with a median duration of 11.7 [7.7–14.9] months. None of the patients had positive surgical margins, five patients (38.5%) were ypT0. Two patients (15.4%) presented intraoperative complications and 1 a severe postoperative complication. Median GFR at 3 months was 84.7 [66.6–95.2] mL/min/1.73 m2 with no significant difference from preoperative GFR. After surgery, immunotherapy was not reintroduced in ten patients (77%). Median follow- up was 25.6 [19.6–30.2] months, median treatment-free survival was 22.4 [15.8–34.7] months. RFS at 12 months and at last follow-up were 84.6% and 53.8%. OS rate at last follow-up was 92.3%. Conclusion: This series demonstrates the feasibility of partial nephrectomy following immune checkpoint inhibitor treatment, with acceptable morbidity rates and no major difficulties specifically attributable to the prior treatment. While the data suggest promising functional and oncological outcomes, further investigation is needed. The study underscores the importance of early re-evaluation of metastatic cases in multidisciplinary tumor boards.