1111 ROBOTIC PARTIAL NEPHRECTOMY FOR SMALL RENAL MASSES IN PATIENTS WITH PRE-EXISTING CHRONIC KIDNEY DISEASE

Abstract

You have accessJournal of UrologyKidney Cancer: Localized I1 Apr 20121111 ROBOTIC PARTIAL NEPHRECTOMY FOR SMALL RENAL MASSES IN PATIENTS WITH PRE-EXISTING CHRONIC KIDNEY DISEASE julien guillotreau, rachid yakoubi, joseph klink, riccardo autorino, jean alexandre Long, sahab hillyer, ranko miocinovic, emad rizkala, humberto Laydner, wahib Isac, robert stein, jihad kaouk, and georges pascal haber julien guillotreaujulien guillotreau cleveland, OH More articles by this author , rachid yakoubirachid yakoubi cleveland, OH More articles by this author , joseph klinkjoseph klink cleveland, OH More articles by this author , riccardo autorinoriccardo autorino cleveland, OH More articles by this author , jean alexandre Longjean alexandre Long cleveland, OH More articles by this author , sahab hillyersahab hillyer cleveland, OH More articles by this author , ranko miocinovicranko miocinovic cleveland, OH More articles by this author , emad rizkalaemad rizkala cleveland, OH More articles by this author , humberto Laydnerhumberto Laydner cleveland, OH More articles by this author , wahib Isacwahib Isac cleveland, OH More articles by this author , robert steinrobert stein cleveland, OH More articles by this author , jihad kaoukjihad kaouk cleveland, OH More articles by this author , and georges pascal habergeorges pascal haber cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1219AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Nephron sparing surgery is now the standard of care for treatment of small renal masses (SRMs)as it carries several advantages over Radical Nephrectomy, including better preservation of renal function and reducing risk of chronic kidney disease (CKD)while achieving similar oncological outcomes.Robotic partial nephrectomy (RPN) is a new option in the surgical management of SRMs but is still under evaluation. The aim of this study was to assess the outcomes of RPN in patients pre-existing CKD and to compare these data to patients with normal renal function METHODS Patients who underwent RPN for renal tumors between 2007 and 2011 were identified from our prospectively maintained institutional database. Perioperative as well as short term oncological and functional outcomes were assessed. A comparative analysis was performed between patients with pre-existing CKD (eGFR15-60ml/min, group 1, n=52) and patients with normal renal function (group 2, n=303). RESULTS Group 1 patients were older (median 68 vs. 57 years, p<0.001), with higher ASA score (3 vs. 2, p<0.001) and a higher Charlson comorbidity index (7 vs 4, p<0.001). Warm ischemia time (WIT) was similar in both groups (18 vs.18 min, p=0.52). Group 1 had a higher postoperative complication rate (40.4% vs. 21.1%, p=0.003). Pathological and oncological data were similar. After a median follow-up of 3 months (IQR: 1-10), deterioration of eGFR was lower in group 1 patients (-5% vs. -12%, p=0.004). No end stage renal disease was noted in either group. There was significantly less CKD upstaging in group 1 than in group 2 (11.5% vs. 33.9%, p=0.001). After multivariate analysis, preoperative eGFR and WIT were independent predictors of latest eGFR. Less than 15% of patients with normal baseline renal function developed CKD stage III or higher. CONCLUSIONS Despite a high risk of surgical complications, RPN is a viable option in patients with preexisting CKD by offering good functional outcomes. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e450-e451 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information julien guillotreau cleveland, OH More articles by this author rachid yakoubi cleveland, OH More articles by this author joseph klink cleveland, OH More articles by this author riccardo autorino cleveland, OH More articles by this author jean alexandre Long cleveland, OH More articles by this author sahab hillyer cleveland, OH More articles by this author ranko miocinovic cleveland, OH More articles by this author emad rizkala cleveland, OH More articles by this author humberto Laydner cleveland, OH More articles by this author wahib Isac cleveland, OH More articles by this author robert stein cleveland, OH More articles by this author jihad kaouk cleveland, OH More articles by this author georges pascal haber cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...