MP70-02 CATABOLIC EFFECTS OF SURGICAL APPROACHES MEASURED BY WEIGHT CHANGE IN PATIENTS UNDERGOING PARTIAL NEPHRECTOMY

Abstract

You have accessJournal of UrologyKidney Cancer: Surgical Therapy V1 Apr 2015MP70-02 CATABOLIC EFFECTS OF SURGICAL APPROACHES MEASURED BY WEIGHT CHANGE IN PATIENTS UNDERGOING PARTIAL NEPHRECTOMY Homayoun Zargar, Oktay Akca, Hiury Andrade, Peter C. Caputo, Daniel Ramirez, Robert J. Stein, Khaled Fareed, and Jihad H. Kaouk Homayoun ZargarHomayoun Zargar More articles by this author , Oktay AkcaOktay Akca More articles by this author , Hiury AndradeHiury Andrade More articles by this author , Peter C. CaputoPeter C. Caputo More articles by this author , Daniel RamirezDaniel Ramirez More articles by this author , Robert J. SteinRobert J. Stein More articles by this author , Khaled FareedKhaled Fareed More articles by this author , and Jihad H. KaoukJihad H. Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2527AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Nephron sparing surgery (NSS) is the treatment of choice for small renal masses. Robotic partial nephrectomy (RPN) has become the most common minimally invasive modality for NSS. The effects of surgical modality on patients' metabolism and in particular extent of postoperative catabolism, in response to surgical trauma have not been well studied. Our aim was to compare early BMI changes post surgery, as a surrogate for trauma stress response, between patients undergoing open partial nephrectomy (OPN) and RPN. METHODS Patients undergoing NSS for a single renal tumor between 2010-2013 were selected for the study. RPN patients were matched with OPN cases based on preoperative BMI and tumor renal nephrometry score (1:1 matching). The lowest BMI post discharge within the first 3 months of surgery was selected and BMI preservation was calculated as proportion of postoperative to preoperative BMI. Univariable and multivariable analyses were performed to assess predictors of BMI loss in our cohort. RESULTS The total of 568 patients (284 pairs) met our inclusion criteria. The two groups were comparable at baseline apart from larger tumours in the OPN group (4 vs. 3 cm; p<0.05). The median time to lowest BMI was comparable between the OPN and RPN groups (24 vs. 29 days; p=0.7). The mean BMI preservation was lower for the OPN group (96.8±4.4 vs. 98.1±4.7%). On multivariable analysis after controlling for age, Charlson comorbidity index, gender, tumor size, nephrometry score, estimated blood loss, occurrence of major complications and pre-operative renal function, the modality of surgery favoring the RPN approach (coefficients B= 1.86 (95% CI (0.57,3.15); p=0.005)) and the occurrence of major complications (coefficients B= -2.96 (95% CI (-5.58, -0.77)); p=0.005) remained significant predictors for BMI preservation after surgery. CONCLUSIONS Occurrence of major complications increases catabolic weight loss after NSS. Minimally invasive NSS delivered by RPN has lower catabolic impact, signified by lower BMI losses in our study, on patients undergoing the procedure compared to OPN. This finding further suggests that RPN delivers minimally invasive surgery beyond the boundaries of just smaller incision sites. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e875 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Homayoun Zargar More articles by this author Oktay Akca More articles by this author Hiury Andrade More articles by this author Peter C. Caputo More articles by this author Daniel Ramirez More articles by this author Robert J. Stein More articles by this author Khaled Fareed More articles by this author Jihad H. Kaouk More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...