MP72-20 DIFFERENTIAL HEMODYNAMIC AND ANTIHYPERTENSIVE CHANGES AFTER PARTIAL NEPHRECTOMY VERSUS RADICAL NEPHRECTOMY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy V1 Apr 2017MP72-20 DIFFERENTIAL HEMODYNAMIC AND ANTIHYPERTENSIVE CHANGES AFTER PARTIAL NEPHRECTOMY VERSUS RADICAL NEPHRECTOMY Ryan Hutchinson, Nirmish Singla, Laura-Maria Krabbe, Solomon Woldu, Gong Chen, Charles Rew, Isamu Tachibana, Yair Lotan, Jeffrey A. Cadeddu, and Vitaly Margulis Ryan HutchinsonRyan Hutchinson More articles by this author , Nirmish SinglaNirmish Singla More articles by this author , Laura-Maria KrabbeLaura-Maria Krabbe More articles by this author , Solomon WolduSolomon Woldu More articles by this author , Gong ChenGong Chen More articles by this author , Charles RewCharles Rew More articles by this author , Isamu TachibanaIsamu Tachibana More articles by this author , Yair LotanYair Lotan More articles by this author , Jeffrey A. CadedduJeffrey A. Cadeddu More articles by this author , and Vitaly MargulisVitaly Margulis More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2256AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Partial nephrectomy is a common therapy for small renal masses and is associated with improved postoperative renal function when compared to radical nephrectomy. The highest quality prospective study of partial versus radical nephrectomy demonstrated worse overall survival in patients undergoing partial nephrectomy which appeared to be driven by cardiovascular outcomes. We examined patients undergoing partial and radical nephrectomy to assess for possible differential postsurgical hemodynamic effects. METHODS An institutional renal mass database was queried for patients undergoing partial or radical nephrectomy between 2006 and 2012. Serial blood pressure followup, clinicopathologic variables and changes in medications including antihypertensives were collected. Patients were excluded for inadequate data, non-curative-intent surgery, non-cancer surgical indication and absence of medication information. Time-dependent changes in blood pressure were compared by split-plot ANOVA and addition or modification of antihypertensive regimen were studied as time-to-event survival analyses with Kaplan-Meier curves and a Cox proportional hazards model. RESULTS Between 2006 and 2012, 402 partial nephrectomies and 205 radical nephrectomies were performed and a final cohort of 264 partial nephrectomy and 130 radical nephrectomy cases was identified with evaluable data. Patients undergoing partial nephrectomy were significantly younger, more likely to have T1 tumors, and had lower preoperative creatinine values (p < 0.001 for all). No differences were noted on postoperative systolic blood pressures, diastolic blood pressures and heart rates (p > 0.05) however, these analyses were underpowered on post-hoc analysis. Significantly more patients who underwent partial nephrectomy started new antihypertensive medications postoperatively (p = <0.001) and surgical treatment remained as a significant independent predictor on multivariate Cox regression (HR 2.51, p = 0.002). CONCLUSIONS Hemodynamic parameters after radical or partial nephrectomy may be different. The etiology of this observation, if any, is currently unexplored. Additional prospective mechanistic investigations are warranted. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e962-e963 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Ryan Hutchinson More articles by this author Nirmish Singla More articles by this author Laura-Maria Krabbe More articles by this author Solomon Woldu More articles by this author Gong Chen More articles by this author Charles Rew More articles by this author Isamu Tachibana More articles by this author Yair Lotan More articles by this author Jeffrey A. Cadeddu More articles by this author Vitaly Margulis More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...