Robotic Partial Nephrectomy in Patients with Chronic Kidney Disease: Objective Measurement of Short- and Long-Term Renal Functional Outcomes.
J Endourol
; 32(7): 630-634, 2018 07.
Article
in En
| MEDLINE
| ID: mdl-29848053
ABSTRACT
BACKGROUND:
Minimal literature informs the use of robotic partial nephrectomy (RPN) in patients with chronic kidney disease (CKD). Therefore, we evaluated the renal functional outcomes in CKD patients undergoing RPN.METHODS:
We reviewed a prospective database of patients undergoing RPN 2010 to 2015 and identified 182 patients who had preoperative and postoperative nuclear renal scintigraphy (at 2 and 12 months postop). Preoperative and 12-month postoperative eGFR (mL/min/1.73 m2, by MDRD) were calculated. CKD was defined as eGFR ≤60 mL/min/1.73 m2 (CKD stages III and IV). Changes in creatinine, eGFR, and split function on mercaptoacetyltriglycine (MAG)-3 scan were compared by baseline CKD status. Correlations between pre- and postoperative eGFR were calculated.RESULTS:
Of 182 patients, 30 (16.5%) had baseline CKD. Preoperative eGFR was 48.5 and 99.0 in CKD and non-CKD patients, respectively (p < 0.001). From preoperation to 12 months postoperation, eGFR decreased by 2.8 and 1.1 mL/min/1.73 m2, respectively (p = 0.6). On MAG-3 scan, the contribution of the surgical kidney to overall renal function decreased by 5.0% and 4.8% (p = 0.9) in the CKD and non-CKD cohorts, respectively. When comparing renal scans at 2 and 12 months postoperation, in both groups the surgical kidney significantly recovered (both p < 0.001) and the patterns of kidney function recovery was similar in both groups (CKD +2.0%, non-CKD +1.4%, p = 0.6). On long-term follow-up (>2 years), eGFR did not change significantly in either the CKD or non-CKD group (-2.8 vs -1.1 mL/min/1.73 m2, p = 0.6). On pathology, tumors were more frequently malignant in CKD vs non-CKD patients (93.3% vs 73.2%, p = 0.02) and of higher Fuhrman Grade (grade ≥3 49.7% vs 28.1%, p < 0.001).CONCLUSION:
RPN is a reasonable treatment option in patients with CKD, as it did not lead to a greater decline in renal function contributed by the surgical kidney. The patterns of kidney function recovery after surgery are similar between patients with and without CKD.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Robotic Surgical Procedures
/
Kidney Neoplasms
/
Nephrectomy
Type of study:
Observational_studies
Aspects:
Patient_preference
Limits:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
J Endourol
Journal subject:
UROLOGIA
Year:
2018
Document type:
Article
Affiliation country:
Lebanon
Country of publication:
EEUU
/
ESTADOS UNIDOS
/
ESTADOS UNIDOS DA AMERICA
/
EUA
/
UNITED STATES
/
UNITED STATES OF AMERICA
/
US
/
USA