MP59-19 ASSESSMENT OF PREDICTORS OF RENAL FUNCTION IMPAIRMENT AFTER ROBOT-ASSISTED PARTIAL NEPHRECTOMY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized IV1 Apr 2014MP59-19 ASSESSMENT OF PREDICTORS OF RENAL FUNCTION IMPAIRMENT AFTER ROBOT-ASSISTED PARTIAL NEPHRECTOMY Vincenzo Ficarra, Alessandro Volpe, Giacomo Novara, Marta Rossanese, Sam Bhayani, and Alexandre Mottrie Vincenzo FicarraVincenzo Ficarra More articles by this author , Alessandro VolpeAlessandro Volpe More articles by this author , Giacomo NovaraGiacomo Novara More articles by this author , Marta RossaneseMarta Rossanese More articles by this author , Sam BhayaniSam Bhayani More articles by this author , and Alexandre MottrieAlexandre Mottrie More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1815AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Little information is available on renal functional impairment after robot-assisted partial nephrectomy (RAPN). Aim of the study was to identify the predictors of postoperative decline of renal function in a large series of patients who underwent elective RAPN for localized renal tumors. Methods We retrospectively analyzed data on 196 consecutive patients who underwent RAPN for localized renal masses at two referral centers from Sep 9/2008 to 9/2010. Serum creatinine (sCr) and estimated glomerular filtration rate (eGFR) calculated with the MDRD equation were assessed in all cases preoperatively and 6 mos after surgery. eGFR values ≥60 ml/min/1.73 m2 were considered normal. The independent role of age, gender, baseline eGFR, surgeon experience, warm ischemia time (WIT) and presence of grade 3-4 postoperative complications according to Clavien/Dindo to predict postoperative RFI was assessed using linear regression analysis. WIT was considered as continuous variable and as categorical variable using cut-off values of 20 min and 30 min. Results Mean patient age was 58.7±12.7 yrs. Mean clinical tumor size and PADUA score were 2.8±1.3 cm and 8.3±1.5, respectively. Mean WIT was 18.3±8.1 minutes. Intra or postoperative complications were observed in 25 cases (12.8%). 40 (20.4%) tumours were benign at pathology. Pathological stage was pT1a in 134 (85.9%) cases, pT1b in 19 (12.2%), pT2 in 2 (1.3%) and 1 pT3a (0.6%). Mean sCr increased from 0.96±0.30 to 1±0.47 mg/dl 6 mos after RAPN (p<0.001). Mean eGFR decreased from 82.2±26.5 to 74.38±27 ml/min/1.73 m2 6 mos after RAPN (p<0.001). In the 168 cases with normal baseline renal function (85.7%), eGFR decreased below 60 ml/min/1.73 m2 in 32 cases (19%). At multivariable analysis only WIT as continuous variable (p=0.03) and baseline eGFR values (p<0.001) turned out to be independent predictors of postoperative eGFR values. The same predictive model was tested using WIT as categorical variable with cut-offs at 20 min and 30 min. In the first model only preoperative eGFR remained statistically significant (p<0.001). In the second model, WIT > 30 min (p=0.03) and baseline eGFR (p<0.001) turned out to be independent predictors of postoperative eGFR. Conclusions A statistically significant decrease of sCr and eGFR occurs 6 months after RAPN. The renal functional loss does not seem to be clinically significant in the majority of cases, but 20% of patients with normal renal function show a clinically significant decline of eGFR values after surgery. eGFR values 6 months after RAPN are mainly influenced by baseline eGFR values and by a WIT >30 minutes. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e657 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Vincenzo Ficarra More articles by this author Alessandro Volpe More articles by this author Giacomo Novara More articles by this author Marta Rossanese More articles by this author Sam Bhayani More articles by this author Alexandre Mottrie More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...