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Assessing Functional Outcomes of Partial Versus Radical Nephrectomy for T1b-T2 Renal Masses: Results from a Multi-institutional Collaboration.
Tappero, Stefano; Bravi, Carlo Andrea; Khene, Zine Eddine; Campi, Riccardo; Pecoraro, Angela; Diana, Pietro; Re, Chiara; Giulioni, Carlo; Beksac, Alp T; Bertolo, Riccardo; Ajami, Tarek; Okhawere, Kennedy E; Meagher, Margaret; Alimohammadi, Arman; Terrone, Carlo; Mari, Andrea; Amparore, Daniele; Da Pozzo, Luigi; Anceschi, Umberto; Suardi, Nazareno; Galfano, Antonio; Larcher, Alessandro; Schiavina, Riccardo; Canda, Erdem; Zhang, Xu; Shariat, Shahrokh; Porpiglia, Francesco; Antonelli, Alessandro; Kaouk, Jihad; Badani, Ketan; Derweesh, Ithaar; Breda, Alberto; Mottrie, Alexander; Dell'Oglio, Paolo.
Afiliación
  • Tappero S; IRCCS Ospedale Policlinico San Martino, Genova, Italy. stefano.m.tappero@gmail.com.
  • Bravi CA; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy. stefano.m.tappero@gmail.com.
  • Khene ZE; Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. stefano.m.tappero@gmail.com.
  • Campi R; Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK.
  • Pecoraro A; Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.
  • Diana P; ORSI Academy, Ghent, Belgium.
  • Re C; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
  • Giulioni C; Department of Urology, University of Rennes, Rennes, France.
  • Beksac AT; Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.
  • Bertolo R; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
  • Ajami T; Department of Urology, Hospital Pederzoli, Peschiera del Garda, Verona, Italy.
  • Okhawere KE; Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain.
  • Meagher M; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
  • Alimohammadi A; ASST-Sette Laghi, Circolo and Fondazione Macchi Hospital, University of Insubria, Varese, Italy.
  • Terrone C; Unit of Urology, Jesi Hospital, Jesi, Ancona, Italy.
  • Mari A; Department of Urology, Polytechnic University of Marche Region, Ancona, Italy.
  • Amparore D; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
  • Da Pozzo L; Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
  • Anceschi U; Department of Urology, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
  • Suardi N; Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
  • Galfano A; University of California, San Diego, La Jolla, CA, USA.
  • Larcher A; Department of Urology, Medical University of Vienna, Vienna, Austria.
  • Schiavina R; IRCCS Ospedale Policlinico San Martino, Genova, Italy.
  • Canda E; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy.
  • Zhang X; Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Clinical and Experimental Medicine, Careggi Hospital, University of Florence, Florence, Italy.
  • Shariat S; Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.
  • Porpiglia F; ASST Papa Giovanni XXIII, Bergamo, Italy.
  • Antonelli A; School of Medicine, University of Milano-Bicocca, Milan, Italy.
  • Kaouk J; Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy.
  • Badani K; Department of Urology, University of Brescia, Brescia, Italy.
  • Derweesh I; Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
  • Breda A; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
  • Mottrie A; Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
  • Dell'Oglio P; Department of Urology, Koç University Hospital, Istanbul, Turkey.
Ann Surg Oncol ; 31(8): 5465-5472, 2024 Aug.
Article en En | MEDLINE | ID: mdl-38802714
ABSTRACT

BACKGROUND:

Deterioration of renal function is associated with increased all-cause mortality. In renal masses larger than 4 cm, whether partial versus radical nephrectomy (PN vs. RN) might affect long-term functional outcomes is unknown. This study tested the association between PN versus RN and postoperative acute kidney injury (AKI), recovery of at least 90% of the preoperative estimated glomerular filtration rate (eGFR) at 1 year, upstaging of chronic kidney disease (CKD) one stage or more at 1 year, and eGFR decline of 45 ml/min/1.73 m2 or less at 1 year.

METHODS:

Data from 23 high-volume institutions were used. The study included only surgically treated patients with single, unilateral, localized, clinical T1b-2 renal masses. Multivariable logistic regression analyses were performed.

RESULTS:

Overall, 968 PN patients and 325 RN patients were identified. The rate of AKI was lower in the PN versus the RN patients (17% vs. 58%; p < 0.001). At 1 year after surgery, for the PN versus the RN patients, the rate for recovery of at least 90% of baseline eGFR was 51% versus 16%, the rate of CKD progression of ≥ 1 stage was 38% versus 65%, and the rate of eGFR decline of 45 ml/min/1.73 m2 or less was 10% versus 23% (all p < 0.001). Radical nephrectomy independently predicted AKI (odds ratio [OR], 7.61), 1-year ≥ 90% eGFR recovery (OR, 0.30), 1-year CKD upstaging (OR, 1.78), and 1-year eGFR decline of 45 ml/min/1.73 m2 or less (OR, 2.36) (all p ≤ 0.002).

CONCLUSIONS:

For cT1b-2 masses, RN portends worse immediate and 1-year functional outcomes. When technically feasible and oncologically safe, efforts should be made to spare the kidney in case of large renal masses to avoid the hazard of glomerular function loss-related mortality.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Lesión Renal Aguda / Tasa de Filtración Glomerular / Neoplasias Renales / Nefrectomía Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Ann Surg Oncol Asunto de la revista: NEOPLASIAS Año: 2024 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Lesión Renal Aguda / Tasa de Filtración Glomerular / Neoplasias Renales / Nefrectomía Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Ann Surg Oncol Asunto de la revista: NEOPLASIAS Año: 2024 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Estados Unidos