Predictive Factors for Postoperative Decline in Renal Functions Following Partial Nephrectomy: Preliminary Results

Objective: We aimed to determine the risk factors related to patient, tumor characteristics and surgery that may be associated with decline in renal function during follow-up after partial nephrectomy (PN). Materials and Methods: Sixty-one patients who underwent PN due to localized stage Ia renal cell carcinoma between January 2010 and October 2018 were retrospectively analyzed. Demographic characteristics of the patients, clinical and pathological data, information about surgical techniques, preoperative score to predict postoperative mortality (POSPOM), Age-adjusted Charlson Comorbidity index (ACCI), Eastern Cooperative Oncology Group score, American Society of Anesthesiologists’ score, preoperative estimated glomerular filtration rate (eGFR) and eGFR levels during postoperative follow-up were recorded. Results: Twelve (19.7%) patients experienced a decline in eGFR (

Parsiyel Nefrektomi Sonrası Böbrek Fonksiyonlarındaki Postoperatif Azalmayı Belirleyici Faktörler: Ön Sonuçlar

Amaç: Parsiyel nefrektomi (PN) sonrası takipte, böbrek fonksiyonlarındaki düşüşü etkileyebilecek hasta, tümör özellikleri ve cerrahi faktörlerle ilişkili risk faktörlerini belirlemeyi amaçladık. Gereç ve Yöntem: Lokalize evre Ia renal hücreli karsinom nedeniyle Ocak 2010 ve Ekim 2018 arasında PN yapılan 61 hasta retrospektif olarak değerlendirildi. Hastaların demografik, klinik ve patolojik verileri, cerrahi tekniklerle ilgili bilgiler, ‘‘Preoperative score to Predict Postoperative Mortality’’ (POSPOM) skoru, Yaşa Göre Düzeltilmiş Charlson Komorbidite indeksi (ACCI), ‘‘Eastern Cooperative Oncology Group’’ skoru, ‘‘American Society of Anesthesiologists’’ skoru, preoperatif tahmini glomerüler filtrasyon hızı (eGFR) ve postoperatif takiplerde bakılan eGFR düzeyleri hesaplanarak kaydedildi. Bulgular: Ortanca 30 aylık postoperatif takipte, hastaların 12’sinin (%19,7) eGFR düzeylerinin 60 mL/dak/1,73 m2’nin altına düşmüş olduğu gözlendi. İleri yaş; yüksek vücut kitle indeksi; hipertansiyon ve diabetes mellitus varlığı; hiler bölge yerleşimli tümör olması; POSPOM, ACCI, RENAL ve PADUA skorlarının yüksek olması; preoperatif düşük eGFR düzeyleri; soğuk iskemi tekniği; total arteryel klempleme tekniği; uzamış sıcak iskemi süresi; uzamış soğuk iskemi süresi ve korunmuş renal parankimal hacim (RPV) oranında azalma, hem erken dönem hem de uzun dönem eGFR’de azalma (

Kaynakça

Rendon RA, Kapoor A, Breau R, Leveridge M, Feifer A, Black PC, So A. Surgical management of renal cell carcinoma: Canadian Kidney Cancer Forum Consensus. Can Urol Assoc J 2014;8:E398-412.

Ljungberg B, Albiges L, Bensalah K, Bex A, Giles RH, Hora M, Kuczyk MA, Kuusk T, Lam TM, Marconi L, Merseburger AS, Powles T, Staehler M, Tahbaz R, Vope A, Bex A. European Association of Urology guidelines on renal cell carcinoma: the 2019 Update. Eur Urol 2019;75:799-810.

Bhindi B, Lohse CM, Schulte PJ, Mason RJ, Cheville JC, Boorjian SA, Leibavich BC, Thampson H. Predicting Renal Function Outcomes After Partial and Radical Nephrectomy. Eur Urol 2019;75:766-772.

Tobert CM, Kahnoski RJ, Thompson DE, Anema JG, Kuntzman RS, Lane BR. RENAL nephrometry score predicts surgery type independent of individual surgeon’s use of nephron sparing surgery. Urology 2012;80:157-161.

Shum CF, Bahler CD, Cary C, Masterson TA, Boris RS, Gardner TA, Kaimakliotis HZ, Foster RS, Bihrle R, Koch MO, JR JES, Sundaram CP. Preoperative nomograms for predicting renal function at 1 year after partial nephrectomy. J Endourol 2017;31:711-718.

Yildiz G, Mağden K, Abdulkerim Y, Ozcicek F, Hür E, Candan F. Glomerular filtration rate: which method should we measure in daily clinical practice? Minerva Med 2013;104:613-623.

Schiavina R, Novara G, Borghesi M, Ficarra V, Ahlawat R, Moon DA, Porpiglia F, Challacombe BJ, Dasgupta P, Brunocilla E, La Manna G, Volpe A, Verma H, Martorana G, Mottrie A. PADUA and R.E.N.A.L. nephrometry scores correlate with perioperative outcomes of robot-assisted partial nephrectomy: analysis of the Vattikuti Global Quality Initiative in Robotic Urologic Surgery (GQIRUS) database. BJU Int 2017;119:456-463.

Kabay S, Ozden H, Yucel M, Tefekli AH, Gulbandilar E, Muslumanoglu AY. Estimation of the Tumor Volume and Volume Ratio on Computed Tomography in Patients with Renal Cell Carcinoma: A Stereological Study. Journal of Health Science 2007;53:664-670.

St-Louis E, Iqbal S, Feldman LS, Sudarshan M, Deckelbaum DL, Razek TS, Khwaja K. Using the age-adjusted Charlson comorbidity index to predict outcomes in emergency general surgery. J Trauma Acute Care Surg 2015;78:318-323.

Le Manach Y, Collins G, Rodseth R, Le Bihan-Benjamin C, Biccard B, Riou B, Devereaux PJ, Landais P. Preoperative Score to Predict Postoperative Mortality (POSPOM): Derivation and Validation. Anesthesiology 2016;124:570-579.

Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Paul C. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982;5:649-655.

Saklad M. Grading of Patients for Surgical Procedures. Anesthesiology 1941;2:281-284.

Kambara T, Tanimoto R, Araki M, Saikab T, Hashimotod H, Oedae T, Tsushima T, Hayata S, Nasu Y, Kobayashi Y. Renal function after nephrectomy influences the risk of cardiovascular events. Acta Med Okayama 2018;72:241-247.

Mir MC, Ercole C, Takagi T, Zhang Z, Velet L, Remer EM, Demirjian S, Campbell SC. Decline in renal function after partial nephrectomy: etiology and prevention. J Urol 2015;193:1889-1898.

Mason R, Kapoor A, Liu Z, Saarela O, Tanguay S, Jewett M, Finelli A, Lacombe L, Kawakami J, Moore R, Morash C, Black P, Rendon RA. The natural history of renal function after surgical management of renal cell carcinoma: Results from the Canadian Kidney Cancer Information System. Urol Oncol 2016;34:486.e1-486.e7.

Mcintosh AG, Parker DC, Egleston BL, Uzzo RG, Haseebuddin M, Joshi SS, Viterbo R, Greenberg RE, Chen DYT, Smaldone MC, Kutikov A. 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 Int 2019;124:999-1005.

Mir MC, Campbell RA, Sharma N, Remer EM, Simmons MN, Li J, Demirjian S, Kaouk J, Campbell SC. Parenchymal volume preservation and ischemia during partial nephrectomy: functional and volumetric analysis. Urology 2013;82:263-268.

Van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A, Borkowski A, Colombel M, Klotz L, Skinner E, Keane T, Marreaud S, Collette S, Sylvester R. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol 2011;59:543-552.

Zhang F, Gao S, Chen XN, Wu B. Clampless and sutureless laparoscopic partial nephrectomy using monopolar coagulation with or without N-butyl-2-cyanoacrylate. World J Surg Oncol 2019;17:72.

Winer AG, Zabor EC, Vacchio MJ, Hakimi AA, Russo P, Coleman JA, Jaimes EA. The Effect of Patient and Surgical Characteristics on Renal Function After Partial Nephrectomy. Clin Genitourin Cancer 2018;16:191-196.

Greco F, Autorino R, Altieri V, Campbell S, Ficarra V, Gill I, Kutikov A, Mottrie A, Mirone V, Poppel HV. Ischemia Techniques in Nephron-sparing Surgery: A Systematic Review and Meta-Analysis of Surgical, Oncological, and Functional Outcomes. Eur Urol 2019;75:477-491.

Spaliviero M, Power NE, Murray KS, Sjoberg DD, Benfante NE, Bernstein ML, Wren J, Russo P, Coleman JA. Intravenous Mannitol Versus Placebo During Partial Nephrectomy in Patients with Normal Kidney Function: A Doubleblind, Clinically-integrated, Randomized Trial. Eur Urol 2018;73:53-59.

Breau RH, Cagiannos I, Knoll G, Morash C1, Cnossen S2, Lavallée LT, Mallick R, Finelli A, Jewett M, Leibovich BC, Cook J, LeBel L, Kapoor A, Poulot F, Izawa J, Rendon R, Fergusson DA. Renal hypothermia during partial nephrectomy for patients with renal tumours: a randomised controlled clinical trial protocol. BMJ Open 2019;9:e025662.

Klingler MJ, Babitz SK, Kutikov A, Campi R, Hatzichristodoulou G, Sanguedolce F, Brookman-May S, Akdogan B, Capitanio U, Roscigno M, Volpe A, Marszalek M, Uzzo R, Antonelli A, Langenhujisen J, Carini M, Minervini A, R Lane B. Assessment of volume preservation performed before or after partial nephrectomy accurately predicts postoperative renal function: Results from a prospective multicenter study.Urol Oncol 2019;37:33-39.

Kim SH, Kang KM, Yu A, Lee JH, Nam BH, Lee ES. A study of relationship of atheroembolic risk factors with postoperative recovery in renal function after partial nephrectomy in patients staged T1-2 renal cell carcinoma during median 4 year follow-up. Cancer Res Treat 2016;48:288-296.

Sejima T, Yumioka T, Yamaguchi N, Masago T, Morizane S, Hikita K, Honda M, Takenaka A. Cross-Sectional Investigations of Pre- and Post-Operative Renal Global Function and Renal Parenchymal Volumetry in Both Partial and Radical Nephrectomy Utilizing Film-Based Technology. Curr Urol 2019;12:127-133.

Lane BR, Russo P, Uzzo RG, Hernandez AV, Boorjian SA, Thompson RH, Fergany AF, Love TE, Campbell SC. Comparison of cold and warm ischemia during partial nephrectomy in 660 solitary kidneys reveals predominant role of nonmodifiable factors in determining ultimate renal function. J Urol 2011;185:421-427.

Simmons MN, Fergany AF, Campbell SC. Effect of parenchymal volume preservation on kidney function after partial nephrectomy. J Urol 2011;186:405-410.

Porpiglia F, Fiori C, Bertolo R, Angusti T, Piccoli GB, Podio V, Russo R. The effects of warm ischaemia time on renal function after laparoscopic partial nephrectomy in patients with normal contralateral kidney. World J Urol 2012;30:257-263.

Leppert JT, Lamberts RW, Thomas IC, Chung BI, Sonn GA, Skinner EC, Wagner TH, Chertow GM, Drooks JD. Incident CKD after Radical or Partial Nephrectomy. J Am Soc Nephrol 2018;29:207-216.

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