Abstract
Composite Outcome Measures in Nephron-Sparing Surgery
Highlights
Nephron-sparing surgery (NSS) has become the standard of surgical management in small renal masses (SRM) due to its ability to achieve similar outcomes as compared to radical nephrectomy, with the additional preservation of renal function
Serum creatinine and estimated glomerular filtration rate using the Modification of Diet in Renal Disease (MDRD) have been the cornerstone of assessing post-operative preserved renal function. Such methods are largely limited in their ability to assess the level of preserved renal function in the operated kidney as the contralateral kidney often compensates for lost function post-operatively
Sophisticated mathematical formulas to estimate resected and ischaemic volume (RAIV) [5], computed tomography (CT) volumetric analysis [3] and tumour contact surface area [6] have been enlisted in an attempt to circumvent this limitation, but require labour-intensive renal volume measurement and advanced imaging technology
Summary
Ong WM1 and Zargar H1,2,* 1Royal Melbourne Hospital, Melbourne, Australia 2Australian Prostate Cancer Research Centre, Melbourne, Australia. The definitions of ‚trifecta’ show slight variation across published literature, they encompass the desire to avoid complications, achieve optimum oncological outcomes and maximise functional renal preservation peri-operatively. Serum creatinine and estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) have been the cornerstone of assessing post-operative preserved renal function. Achievement of each of this composite outcomes correlated with better functional outcomes post-operatively assess by MAG3 renal scan validating their utility as surrogates for functional renal preservation post-partial nephrectomy. Standardisation of reporting of results and more reliable tools for measurement of outcomes are essential in establishing robust data to serve as a benchmark for gauging surgical quality and assess for attainability of ‘nephron-sparing’ in NSS. WIT longer in RAPN vs. OPN but similar post-op renal function. eGFR lower in post-op LPN vs. OPN but similar in long term
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