PD49-05 COMPARISON OF RENAL FUNCTION DETRIMENTS AFTER LOCAL TUMOR ABLATION OR PARTIAL NEPHRECTOMY FOR RENAL CELL CARCINOMA

Abstract

You have accessJournal of UrologyKidney Cancer: Surgical Therapy VI1 Apr 2015PD49-05 COMPARISON OF RENAL FUNCTION DETRIMENTS AFTER LOCAL TUMOR ABLATION OR PARTIAL NEPHRECTOMY FOR RENAL CELL CARCINOMA Alessandro Larcher, Malek Meskawi, Katharina Boehm, Roger Valdivieso, Vincent Trudeau, Zhe Tian, Nicola Fossati, Giovanni Lughezzani, Nicolò Buffi, Giorgio Guazzoni, Francesco Montorsi, Maxine Sun, and Pierre Karakiewicz Alessandro LarcherAlessandro Larcher More articles by this author , Malek MeskawiMalek Meskawi More articles by this author , Katharina BoehmKatharina Boehm More articles by this author , Roger ValdiviesoRoger Valdivieso More articles by this author , Vincent TrudeauVincent Trudeau More articles by this author , Zhe TianZhe Tian More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Giovanni LughezzaniGiovanni Lughezzani More articles by this author , Nicolò BuffiNicolò Buffi More articles by this author , Giorgio GuazzoniGiorgio Guazzoni More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Maxine SunMaxine Sun More articles by this author , and Pierre KarakiewiczPierre Karakiewicz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2723AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Local tumor ablation (LTA) and partial nephrectomy (PN) represent treatment alternatives for patients diagnosed with small renal mass and both may result in renal function detriments. The aim of the study was to compare renal function detriments after LTA or PN. METHODS A Surveillance Epidemiology and End Results-Medicare-linked retrospective cohort of 2850 T1 kidney cancer patients who underwent LTA or PN between 2000 and 2009 was abstracted. Short-term outcomes consisted of 30-day acute kidney injury (AKI) and 30-day dialysis rates. Long-term outcomes consisted of episodes of AKI, mild (EGFR 90-60) and moderate-severe (EGFR<60) chronic kidney disease (CKD), end-stage renal disease, hemodialysis and anemia in CDK. After propensity score matching to control for measurable selection bias, multivariable models addressing the impact of LTA vs. PN on short-term (logistic regression) and long term (Cox regression) renal function detriments were fitted. RESULTS Median follow-up was 35 months among survivors. Fewer patients (20%; n=561) were treated with LTA, while most (80%; n=2289) were treated with PN. Patients treated with LTA were older, more frequently unmarried, sicker, more frequently diagnosed with T1a stage and more frequently diagnosed with unspecified subtype of renal cell carcinoma (all p<0.05). In patients treated with LTA, approach was open, laparoscopic and percutaneous in 7% (n=38), 53% (n=299), 40% (n=224) of the cohort, respectively. In patients treated with PN, approach was open, laparoscopic and robotic in 72% (n=1663), 23% (n=521) and 5% (n=105) of the cohort, respectively. Following a 1:1 ratio propensity score matching for all covariates, 561 LTA and 561 PN patients remained. The 30-day incidence of AKI was 4.6% after LTA and 9.4% after PN. In multivariable analyses (MVA), LTA was associated with a lower AKI rate (OR 0.42, p=0.001). The 30-day incidence of any dialysis was <2% after either LTA or PN. In MVA, LTA was not associated with a lower rate of any dialysis (OR 0.43, p=0.2). At long-term assessment, both the unadjusted and adjusted rates of all six examined endpoints were not different between LTA and PN (all p>0.5). Similar results were recorded in a sub-analysis of patients with stage T1a. CONCLUSIONS LTA offers short-term protective effect from AKI. The short-term rates of any dialysis treatment are similar after either LTA or PN. At long-term assessment, LTA and PN renal function detriment rates are not different. Concern for long-term functional outcomes should not be a barrier for PN. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e972-e973 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alessandro Larcher More articles by this author Malek Meskawi More articles by this author Katharina Boehm More articles by this author Roger Valdivieso More articles by this author Vincent Trudeau More articles by this author Zhe Tian More articles by this author Nicola Fossati More articles by this author Giovanni Lughezzani More articles by this author Nicolò Buffi More articles by this author Giorgio Guazzoni More articles by this author Francesco Montorsi More articles by this author Maxine Sun More articles by this author Pierre Karakiewicz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...