Ross Mason1, Anil Kapoor2, Zhihui Liu3, Olli Saarela3, Simon Tanguay4, Michael Jewett5, Antonio Finelli5, Louis Lacombe6, Jun Kawakami7, Ronald Moore8, Christopher Morash9, Peter Black10, Ricardo A Rendon11. 1. Department of Urology, Dalhousie University and QEII Health Sciences Centre, Halifax, Canada. 2. Division of Urology, McMaster University, Hamilton, Ontario, Canada. 3. Dalai Lama School of Public Health, University of Toronto, Toronto, Ontario, Canada. 4. Division of Urology, McGill University, Montreal, Québec, Canada. 5. Department of Surgery (Urology) and Surgical Oncology, University Health Network and Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada. 6. Division of Urology, Université Laval, Quebec City, Quebec, Canada. 7. Division of Urology, University of Calgary, Calgary, Alberta, Canada. 8. Division of Urology, University of Alberta, Edmonton, Alberta, Canada. 9. Division of Urology, University of Ottawa, Ottawa, Ontario, Canada. 10. Department of Urologic Sciences, University of British Colombia, British Colombia, Canada. 11. Department of Urology, Dalhousie University and QEII Health Sciences Centre, Halifax, Canada. Electronic address: rrendon@dal.ca.
Abstract
INTRODUCTION AND OBJECTIVE: Patients who undergo surgical management of renal cell carcinoma (RCC) are at risk for chronic kidney disease and its sequelae. This study describes the natural history of renal function after radical and partial nephrectomy and explores factors associated with postoperative decline in renal function. METHODS: This is a multi-institutional cohort study of patients in the Canadian Kidney Cancer Information System who underwent partial or radical nephrectomy for RCC. Estimated glomerular filtration rate (eGFR) and stage of chronic kidney disease were determined preoperatively and at 3, 12, and 24 months postoperatively. Linear regression was used to determine the association between postoperative eGFR and type of surgery (radical vs. partial), duration of ischemia, ischemia type (warm vs. cold), and tumor size. RESULTS AND LIMITATIONS: With a median follow-up of 26 months, 1,379 patients were identified from the Canadian Kidney Cancer Information System database including 665 and 714 who underwent partial and radical nephrectomy, respectively. Patients undergoing radical nephrectomy had a lower eGFR (mean = 19ml/min/1.73m2 lower) at 3, 12, and 24 months postoperatively (P<0.001). Decline in renal function occurred early and remained stable throughout follow-up. A lower preoperative eGFR and increasing age were also associated with a lower postoperative eGFR (P<0.01). Ischemia type and duration were not predictive of postoperative decline in eGFR (P>0.05). Severe renal failure (eGFR<30ml/min/1.73m2) developed postoperatively in 12.5% and 4.1% of radical and partial nephrectomy patients, respectively (P<0.001). CONCLUSIONS: After the initial postoperative decline, renal function remains stable in patients undergoing surgery for RCC. Patients undergoing radical nephrectomy have a greater long-term reduction in renal function compared with those undergoing partial nephrectomy. Ischemia duration and type are not predictive of postoperative renal function when adhering to generally short ischemia durations.
INTRODUCTION AND OBJECTIVE:Patients who undergo surgical management of renal cell carcinoma (RCC) are at risk for chronic kidney disease and its sequelae. This study describes the natural history of renal function after radical and partial nephrectomy and explores factors associated with postoperative decline in renal function. METHODS: This is a multi-institutional cohort study of patients in the Canadian Kidney Cancer Information System who underwent partial or radical nephrectomy for RCC. Estimated glomerular filtration rate (eGFR) and stage of chronic kidney disease were determined preoperatively and at 3, 12, and 24 months postoperatively. Linear regression was used to determine the association between postoperative eGFR and type of surgery (radical vs. partial), duration of ischemia, ischemia type (warm vs. cold), and tumor size. RESULTS AND LIMITATIONS: With a median follow-up of 26 months, 1,379 patients were identified from the Canadian Kidney Cancer Information System database including 665 and 714 who underwent partial and radical nephrectomy, respectively. Patients undergoing radical nephrectomy had a lower eGFR (mean = 19ml/min/1.73m2 lower) at 3, 12, and 24 months postoperatively (P<0.001). Decline in renal function occurred early and remained stable throughout follow-up. A lower preoperative eGFR and increasing age were also associated with a lower postoperative eGFR (P<0.01). Ischemia type and duration were not predictive of postoperative decline in eGFR (P>0.05). Severe renal failure (eGFR<30ml/min/1.73m2) developed postoperatively in 12.5% and 4.1% of radical and partial nephrectomy patients, respectively (P<0.001). CONCLUSIONS: After the initial postoperative decline, renal function remains stable in patients undergoing surgery for RCC. Patients undergoing radical nephrectomy have a greater long-term reduction in renal function compared with those undergoing partial nephrectomy. Ischemia duration and type are not predictive of postoperative renal function when adhering to generally short ischemia durations.
Authors: Wassim Kassouf; Leonardo L Monteiro; Darrel E Drachenberg; Adrian S Fairey; Antonio Finelli; Anil Kapoor; Jean-Baptiste Lattouf; Michael J Leveridge; Nicholas E Power; Frederic Pouliot; Ricardo A Rendon; Robert Sabbagh; Alan I So; Simon Tanguay; Rodney H Breau Journal: Can Urol Assoc J Date: 2018-05-31 Impact factor: 1.862
Authors: Alice Dragomir; Armen Aprikian; Anil Kapoor; Antonio Finelli; Frédéric Pouliot; Ricardo Rendon; Peter C Black; Ronald Moore; Rodney H Breau; Jun Kawakami; Darrell Drachenberg; Jean-Baptiste Lattouf; Simon Tanguay Journal: CMAJ Open Date: 2017-12-11