Assessing the Surgical Safety of Nephrectomy Post-HIF-2α Antagonist Therapy

Nephrectomy after HIF-2α antagonist exposure appears feasible and safe in patients with VHL-associated renal tumors, supporting integration of targeted systemic therapy into surgical workflows.

The retrospective single-center cohort included 27 patients who underwent 28 nephrectomies and evaluated bleeding/transfusion, operative metrics, and postoperative complications. The researchers found perioperative transfusion rates, estimated blood loss, warm ischemia times, and complication profiles that align with contemporary nephrectomy benchmarks, suggesting prior HIF-2α antagonist exposure does not, by itself, preclude surgery in appropriately selected cases.

Perioperative challenges mirrored those expected with complex partial nephrectomy—moderate blood loss, intermittent warm ischemia during tumor excision, and the technical demands of robotic approaches in most cases. Early postoperative concerns were limited, with a low transfusion frequency and two major complications among the series.

Longer-term oncologic and renal-function outcomes remain limited and require structured follow-up to assess durability of cancer control and renal preservation after combined therapy and surgery.