You have accessJournal of UrologyKidney Cancer: Localized IV1 Apr 2014MP59-02 RENAL FUNCTION IMPAIRMENT AFTER NEPHRON SPARING SURGERY OR RADICAL NEPHRECTOMY IN PATIENTS WITH CLINICAL T1A-T1B RENAL MASS AND NORMAL PREOPERATIVE GLOMERULAR FILTRATION RATES: RESULTS FROM A LARGE MULTI-INSTITUTIONAL STUDY Umberto Capitanio, Carlo Terrone, Alessandro Antonelli, Andrea Minervini, Alessandro Volpe, Fabio Castiglione, Maria Furlan, Rayan Matloob, Federica Regis, Luisa Zegna, Gianni Vittori, Ettore Di Trapani, Marco Carini, Claudio Simeone, Francesco Montorsi, and Roberto Bertini Umberto CapitanioUmberto Capitanio More articles by this author , Carlo TerroneCarlo Terrone More articles by this author , Alessandro AntonelliAlessandro Antonelli More articles by this author , Andrea MinerviniAndrea Minervini More articles by this author , Alessandro VolpeAlessandro Volpe More articles by this author , Fabio CastiglioneFabio Castiglione More articles by this author , Maria FurlanMaria Furlan More articles by this author , Rayan MatloobRayan Matloob More articles by this author , Federica RegisFederica Regis More articles by this author , Luisa ZegnaLuisa Zegna More articles by this author , Gianni VittoriGianni Vittori More articles by this author , Ettore Di TrapaniEttore Di Trapani More articles by this author , Marco CariniMarco Carini More articles by this author , Claudio SimeoneClaudio Simeone More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Roberto BertiniRoberto Bertini More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1798AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Some reports suggested that nephron sparing surgery (NSS) may protect against renal function impairment (RFI) when compared with radical nephrectomy (RN) in patients with small renal masses. In the current study, we aimed to test the effect of treatment type (NSS vs. RN) on prevalence of RFI and renal end-stage kidney disease (ESRD) after accounting for clinical characteristics, comorbidities and individual cardiovascular risk. Methods A multi-institutional collaboration among four European Tertiary Care Centers allowed collecting 2024 patients with a clinical T1a-T1b N0 M0 renal mass and complete functional follow-up data. Patients underwent RN (n=765, 37.8%) or NSS (n=1259, 62.2%) and showed normal estimated glomerular filtration rates (eGFR) before surgery (defined as a pre-operative eGFR≥60 ml/min/1.73 m2). Univariable and multivariable Cox regression analyses predicting RFI were performed. To adjust for inherent baseline differences among patients, we included as covariates: preoperative creatinine, age, clinical tumor size, gender, presence of hypertension or diabetes at diagnosis, baseline Charlson comorbidity index (CCI), body mass index and smoker status. Results At a mean follow up period of 68.2 months, 81.1% vs. 55.8% patients showed normal renal function after NSS vs. RN, respectively (p<0.001). The prevalence of mild RFI, severe RFI and ESRD resulted 25.3, 1.0% and 2.1%. However, after stratifying for treatment type, the prevalence of mild RFI, severe RFI and ESRD resulted higher in the group of patients treated with RN relative to NSS (39.7 vs. 16.6%, 1.4 vs. 0.8% and 3.0 vs. 1.5%, respectively, p<0.001). At multivariable analyses, patients who underwent PN showed significantly lower risk to harbour RFI compared with their RN-treated counterparts (hazard ratio [HR]: 0.63; 95% confidence interval, 0.44-0.89; p=0.008). Increasing age (HR: 1.06, p<0.001), larger tumors (HR: 1.04, p<0.001), presence of hypertension (HR: 5.39, p=0.006) and presence of diabetes (HR: 1.56, p=0.05) resulted independent predictors of RFI. Conclusions Although the risk of severe renal function impairment and ESRD is negligible, up to 30% of the patients with clinical T1a-T1b renal masses and a normal preoperative kidney function harbour mild RFI after surgery. Also after accounting for clinical characteristics, comorbidities and cardiovascular risk at diagnosis, NSS significantly decrease the risk of RFI relative to RN. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e650 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Umberto Capitanio More articles by this author Carlo Terrone More articles by this author Alessandro Antonelli More articles by this author Andrea Minervini More articles by this author Alessandro Volpe More articles by this author Fabio Castiglione More articles by this author Maria Furlan More articles by this author Rayan Matloob More articles by this author Federica Regis More articles by this author Luisa Zegna More articles by this author Gianni Vittori More articles by this author Ettore Di Trapani More articles by this author Marco Carini More articles by this author Claudio Simeone More articles by this author Francesco Montorsi More articles by this author Roberto Bertini More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...