Categorized Preoperative Estimated Glomerular Filtration Rate as a Criterion for Choosing Between Radical or Partial Nephrectomy for Renal Tumor

602 Background: To compare and analyze surgical, oncological and functional outcomes of transperitoneal (TRPN) and retroperitoneal robotic partial nephrectomy (RRPN). Methods: Out of 566 consecutive patients who underwent RAPN by a single surgeon from December 2008 to July 2017, this study included 523 patients (TRPN 310, RRPN 213) who evaluated preoperative and 1-year postoperative estimated glomerular filtration rate (eGFR). Our primary endpoint was to compare the perioperative and postoperative outcomes of both approaches by the measure of Pentafecta (negative surgical margin, no 30-day complication, warm ischemic time (WIT) ≤25 minutes, return of estimated glomerular filtration rate (eGFR) to > 90% from baseline and no upstaging of chronic kidney disease). Secondary endpoint was to find the factors associated with Pentafecta by multivariate regression analysis. Results: No significant difference was found in terms of age, BMI, laterality, history of hypertension or diabetes, ASA grade, tumor size and RENAL nephrometry score. These outcomes were lower in the RRPN group: operative time [median (IQR) 244 (202-295) vs. 273 (230-314); p < 0.001], WIT [median (IQR) 19 (15-25) vs. 21 (16-27); p < 0.008] and estimated blood loss (EBL) [median (IQR) 100 (60-200) vs. 150 (100-200); p < 0.003]. Hospital stay, baseline eGFR, 1-year postoperative eGFR, the rate of Pentafecta achievement, recurrence and complications were not different. The rate of WIT ≤ 25 minutes was solely significantly different (TRPN 69.7% vs. RRPN 77.9%, p = 0.045) in the Pentafecta criteria. Multivariate analysis revealed tumor size [OR (95% CI) 0.641 (0.536-0.767), p < 0.001) and hospital stays (OR 0.639, p < 0.001) as predictive for lack of Pentafecta. Conclusions: RRPN demonstrated less operative time, WIT and EBL than TPRN. Pentafecta achievements were equivalent in both approaches. Tumor size and hospital stays were found as predictive factors of Pentafecta.

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Tumor Volume and Tumor Crossing of the Axial Renal Midline as Preoperative Predictors of Reduced Estimated Glomerular Filtration Rate After Robotic Partial Nephrectomy

10.21203/rs.3.rs-538641/v1 ◽

2021 ◽

Author(s):

Haruyuki Ohsugi ◽

Kyojiro Akiyama ◽

Hisanori Taniguchi ◽

Masaaki Yanishi ◽

Motohiko Sugi ◽

...

Keyword(s):

Renal Function ◽

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Partial Nephrectomy ◽

Filtration Rate ◽

Tumor Volume ◽

Estimated Glomerular Filtration Rate ◽

Scoring Systems ◽

Renal Tumors ◽

Robotic Partial Nephrectomy

Abstract The ability of nephrometry scoring systems, including the radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, and location relative to polar lines (R.E.N.A.L.), to predict loss of renal function after robotic partial nephrectomy (RPN) is still controversial. Therefore, we verified which combination of factors from nephrometry scoring systems, including tumor volume, was the most significant predictor of postoperative renal function. Patients who underwent RPN for cT1 renal tumors in our hospital were reviewed retrospectively (n=163). The preoperative clinical data (estimated glomerular filtration rate [eGFR], comorbidities, and nephrometry scoring systems including R.E.N.A.L.) and perioperative outcomes were evaluated. We also calculated the tumor volume using the equation applied to an ellipsoid by three-dimensional computed tomography. The primary outcome was reduced eGFR, which was defined as an eGFR reduction of ≥20% from baseline to 6 months after RPN. Multivariate logistic regression analyses were used to evaluate the relationships between preoperative variables and reduced eGFR. Of 163 patients, 24 (14.7%) had reduced eGFR. Multivariate analyses indicated that tumor volume (cutoff value≥14.11 cm3, indicating a sphere with a diameter≥approximately 3 cm) and tumor crossing of the axial renal midline were independent factors for reduced eGFR (odds ratio [OR], 4.57; P=0.003 and OR, 3.21; P=0.034, respectively). Our classification system using these two factors showed a higher area under the receiver operating characteristic curve (AUC) than previous nephrometry scoring systems (AUC=0.786 vs. 0.653–0.719), and it may provide preoperative information for counseling patients about renal function after RPN.

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Prediction of significant estimated glomerular filtration rate decline after renal unit removal to aid in the clinical choice between radical and partial nephrectomy in patients with a renal mass and normal renal function

BJU International ◽

10.1111/bju.14839 ◽

2019 ◽

Vol 124 (6) ◽

pp. 999-1005 ◽

Cited By ~ 4

Author(s):

Andrew G. McIntosh ◽

Daniel C. Parker ◽

Brian L. Egleston ◽

Robert G. Uzzo ◽

Mohammed Haseebuddin ◽

...

Keyword(s):

Renal Function ◽

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Partial Nephrectomy ◽

Normal Renal Function ◽

Renal Mass ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Renal Unit ◽

Glomerular Filtration Rate Decline

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Microwave Thermal Ablation versus Open Partial Nephrectomy for the Treatment of Small Renal Tumors in Patients Over 70 Years Old

Medicina ◽

10.3390/medicina55100664 ◽

2019 ◽

Vol 55 (10) ◽

pp. 664 ◽

Cited By ~ 1

Author(s):

Anglickis ◽

Anglickienė ◽

Andreikaitė ◽

Skrebūnas

Keyword(s):

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Partial Nephrectomy ◽

Kidney Cancer ◽

Thermal Ablation ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Hemoglobin Level ◽

Renal Tumors ◽

Open Partial Nephrectomy

Background and objectives: Microwave thermal ablation (MWT) is one of the treatment options for kidney cancer. However, for patients over 70 years old the safety and oncological efficacy of this treatment is still controversial. The goal of this study was to compare MWT with open partial nephrectomy (OPN) and to find out whether MWT is preferable in maintaining patient renal function and reducing the risk of postoperative complications. Materials and Methods: Depending on the treatment choice, all patients were divided into two groups: an MWT group and an open kidney resection (OPN) group. Data have been retrospectively collected for 7 years, starting with January 2012 up to January 2019. A total number of 33 patients with exophytic, single small renal masses were treated with either OPN (n = 18) or MWT (n = 15). All patients had histologically proven T1 kidney cancer. MWT was performed for patients who refused to have OPN or in those cases where the collecting system, renal calyx, and great vessels were free from tumor margins of more than 1 cm. Results: In the MWT group a median (IQR) patients’ age was 75 years (71–79) years, in the OPN group—71.5 (70–75) years, p = 0.005. A median (IQR) Charleston comorbidity index in the MWT group was 7.5 (5–10) and in the same way in the OPN group it was 5.22 (5–6), p = 0.005. A median (IQR) estimated glomerular filtration rate (eGFR) before surgery was higher in the MWT group 59.9 (49.5–73.8) mL/min/1.73 m2 vs. 46.2 (42.7–65.8) mL/min/1.73 m2 in the OPN group, p = 0.12. Three days following the surgery a median (IQR) eGFR was 56.45 (46.6–71.9) in MWT group mL/min/1.73 m2 vs. 43.45 (38.3–65) mL/min/1.73 m2) in the OPN group, p = 0.30. A median (IQR) of primary hemoglobin level was lower in the MWT group compared with the OPN group (134.5 (124–140) g/L vs. 125 (108–138) g/L), p = 0.41. However, after the surgery a median (IQR) lower hemoglobin level was detected in the OPN group (123.5 (111–134) g/L vs. 126 (112–135)), p = 0.53. The median (IQR) duration of the procedure in MWT group was shorter compared with the OPN group (26 (25–30) min vs. 67.5 (55–90) min), p < 0.0001. A median (IQR) hospitalization time was shorter in MWT group (3 (2–3) days vs. 89 (7–11.5) days), p < 0.0001. Pain by the visual analogue scale (VAS) scale the first day after surgery was significantly lower—median (IQR) in the MWT group was 2 (1–3) vs. 4 (3–6)), p = 0.008. Treatment failure rate was numerically higher in MWT (1/15 vs. 0/18, p = 0.56). Conclusions: Pain level on the next day after surgery, mean number of hospitalization and operation time were significantly lower in the MWT group than in the OPN group. The blood loss estimated glomerular filtration rate and oncologic data between the two groups was not statistically significant.

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