preprint · Preprints.org
Nephron-sparing surgery is the favoured treatment for localized renal cell carcinoma, yet open radical nephrectomy remains the dominant approach in low- and middle-income countries due to technological and training constraints. A retrospective evaluation examined 38 patients with localized renal tumours who underwent open partial nephrectomy across two tertiary hospitals in Cameroon from 2015 to 2024. All surgical procedures were completed without conversion. The mean warm ischemia time was 17.7 minutes, and negative surgical margins were achieved in 97.4% of cases. Complications occurred in 34% of patients, all of which were minor. Surgical success, defined by trifecta achievement of negative margins, brief ischemia time, and minimal complications, was reached in 79% of operations. Two-year recurrence-free survival stood at 94.7% with no cancer-specific deaths, indicating that open partial nephrectomy is feasible, safe, and effective for kidney preservation in resource-constrained environments.
In many developing healthcare systems, complete kidney removal remains common for localized tumours, leading to higher long-term risks of chronic kidney disease. Demonstrating that partial kidney removal is safe and effective using standard open surgery allows hospitals in lower-income settings to deliver international standards of cancer care and preserve organ function without needing costly, advanced surgical technologies.
This research provides clinical evidence supporting the routine adoption of open partial nephrectomy protocols and related surgical training programmes in low- and middle-income healthcare centres. The intervention represents applied and tested clinical practice directly usable by surgeons and healthcare administrators, though the abstract does not indicate any specific commercial product, medical device, or industrial application pathway.
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Background/Objectives: Renal cell carcinoma (RCC) increasingly presents at localized stages, and nephron-sparing surgery is the preferred treatment where feasible. In low- and middle-income countries (LMICs), however, open radical nephrectomy remains predominant due to limited technology and expertise. This study evaluates the feasibility, functional outcomes, and oncologic efficacy of open partial nephrectomy (OPN) in a resource-limited setting. Methods: We conducted a retrospective review of 38 patients with localized renal tumors (cT1–T2 N0M0) who underwent OPN at two tertiary hospitals in Cameroon between 2015 and 2024. Sociodemographic, perioperative, pathological, and follow-up data were analyzed. Primary outcomes included trifecta achievement (negative margins, warm ischemia time ≤25 minutes, and absence of ≥Clavien II complications), renal function preservation, and two-year recurrence-free survival (RFS). Logistic regression identified predictors of functional decline and trifecta non-achievement. Results: Median patient age was 56 years, with a male predominance (63%). Mean tumor size was 4.6 cm; 42% were cT1a, 50% cT1b, and 8% cT2a. All procedures were completed without conversion. The mean warm ischemia time was 17.7 minutes, and transfusion was required in 10.5% of patients. Overall complication rate was 34%, all minor. Negative surgical margins were achieved in 97.4%. Two-year RFS was 94.7%, with no cancer-specific deaths. Mean eGFR declined by 13.4% at 12 months; warm ischemia time independently predicted significant functional loss. Trifecta was achieved in 79% of cases. Conclusions: OPN is feasible and safe in LMICs, providing excellent cancer control and renal preservation. Wider adoption could reduce the burden of chronic kidney disease in resource-limited settings.
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DOI: 10.20944/preprints202508.2015.v1
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