1369 PERIOPERATIVE MORBIDITY AND RENAL FUNCTION IN PATIENTS UNDERGOING ELECTIVE NEPHRON-SPARING SURGERY OR RADICAL NEPHRECTOMY FOR RENAL TUMORS LARGER THAN 4 CM IN A MATCHED COHORT

Abstract

You have accessJournal of UrologyKidney Cancer: Localized IV1 Apr 20101369 PERIOPERATIVE MORBIDITY AND RENAL FUNCTION IN PATIENTS UNDERGOING ELECTIVE NEPHRON-SPARING SURGERY OR RADICAL NEPHRECTOMY FOR RENAL TUMORS LARGER THAN 4 CM IN A MATCHED COHORT Frederik C. Roos, Wolfgang Jaeger, Melanie Mueller, Christian Hampel, Joachim W. Thueroff, and Walburgis Brenner Frederik C. RoosFrederik C. Roos More articles by this author , Wolfgang JaegerWolfgang Jaeger More articles by this author , Melanie MuellerMelanie Mueller More articles by this author , Christian HampelChristian Hampel More articles by this author , Joachim W. ThueroffJoachim W. Thueroff More articles by this author , and Walburgis BrennerWalburgis Brenner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.997AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We analysed renal function and perioperative morbidity in patients treated by radical nephrectomy (RN) or elective nephron-sparing surgery (NSS) for renal tumors larger than 4 cm. METHODS From our database, we identified retrospectively 829 patients treated with either RN (n=641) or NSS (n=188) for renal masses larger than 4 cm. After matching the cohort for age, time of surgery, histology, grading, TNM, size gender, and excluding patients with imperative indication and metastases, 247 remained for functional analyses. RN and elective NSS was performed in 100 and 73 patients. Preoperative and at least 30 days postoperative serum creatinin (SCr) values were used to estimate glomerular filtration rate (eGFR). Chronic kidney disease (CKD) was defined as eGFR <60 ml/min/1.73m2 and cox proportional hazard regression was used to identify clinical risk factors for CKD. Clinical features having an impact on the rate of complications were assessed using linear and binomial regression. RESULTS Between RN and NSS significant differences were found in median tumor size (5.5 vs. 5.0 cm, p=0.003) and in median follow-up until last postoperative SCr measurement (6.87 vs. 3.57 years, p=0.005). Patients undergoing RN had more cardiovascular comorbidities (p<001) and a higher ASA-score (p=0.002) than patients treated by NSS. The complication rates did not differ between the groups (p=0.091), although ASA-score of 3+4 was associated with an increased risk (2.48, p=0.005). Median preoperative and ultimate eGFR were 79 and 74 ml/min/1.73m2 for NSS and 77 and 57 ml/min/1.73m2 for RN. Increasing age (HR:1.06, p<0.001) history of hypertension (HR:1.67, p=0.046) and RN (HR:2.11, p=0.016) were associated with an increased risk of developing CKD postoperatively in multivariate analysis, whereas tumor size had no impact (1.71, p=0.451). CONCLUSIONS Patients undergoing RN for renal tumors larger than 4cm had a significantly higher risk of developing CKD than patients treated by elective NSS. The complication rate did not differ between the groups, also for tumors exceeding 7cm. Our findings suggest performing NSS also for tumors larger than 4 cm when feasible in carefully selected patients for preserving renal function. Patients demographics and clinical characteristics stratified after type of surgery. Clinical Features Elective NSS (n= 101) RN (n=146) (p-value) Gender (% male) 56(55.4) 87(59.6) 0.518 Age years (range) 58(23-84) 62(31-84) 0.251 Smokers (%) 33(32.6) 24(16.4) 0.030 Symptoms at diagnosis (%) 17(16.8) 35(23.9) 0.177 Hospitalization, days (rannge) 8(4-17) 8(4-39) 0.208 Follow-up (%) 73(72.3) 104(71.3) 0.487 Follow-up renal function, years (range) 3.57(0.14-18.10) 6.87(0.15-19.24) 0.005 Comorbidities ASA 3+4 (%) 36(35.6) 74(50.7) 0.002 Cardiovascular (%) 35(34.6) 81(55.4) 0.000 Hypertension (%) 22(21.8) 63(43.2) 0.001 Coronary heart disease (%) 2(2.0) 19(13.0) 0.002 Pulmonary (%) 2(2.0) 11(7.5) 0.888 Diabetes mellitus (%) 4(4.0) 12(8.2) 0.190 Obesity (%) 7(6.9) 20(13.7) 0.100 Secondary malignancy (%) 32(31.7) 34(23.3) 0.002 Tumor characeristics Pathological Tumor Size, cm (range) 5.0(4.2-16.0) 5.5(4.3-14.0) 0.003 G3 (%) 10(13.7) 16(16) 0.569 pT3 (%) 6(8.2) 6(6.0) 0.740 benign lesions (%) 23(22.8) 26(17.8) 0.337 Mainz, Germany© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e528-e529 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Frederik C. Roos More articles by this author Wolfgang Jaeger More articles by this author Melanie Mueller More articles by this author Christian Hampel More articles by this author Joachim W. Thueroff More articles by this author Walburgis Brenner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...