Alessandro Antonelli1, Andrea Mari2, Nicola Longo3, Giacomo Novara4, Francesco Porpiglia5, Riccardo Schiavina6, Vincenzo Ficarra4, Marco Carini2, Andrea Minervini7. 1. Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy. 2. Department of Urology, University of Florence, Careggi Hospital, Florence, Italy. 3. Department of Urology, Federico II Hospital, University of Naples, Naples, Italy. 4. Department of Urology, University of Padua, Padua, Italy. 5. Department of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy. 6. Department of Urology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. 7. Department of Urology, University of Florence, Careggi Hospital, Florence, Italy. Electronic address: andreamine@libero.it.
Abstract
PURPOSE: We sought to determine the predictors of short-term and long-term renal function impairment after partial nephrectomy. MATERIALS AND METHODS: Clinical data on 769 consecutive patients who underwent partial nephrectomy were prospectively recorded at a total of 19 urological Italian centers from 2009 to 2012 in the RECORd 1 (Italian Registry of Conservative Renal Surgery) Project. We extracted clinical data on 708 of these patients who were alive, free of recurrent disease and with a minimum 2-year functional followup. RESULTS: Of the patients 47.3% underwent open, 36.6% underwent laparoscopic and 16.1% underwent robot-assisted partial nephrectomy. The median baseline estimated glomerular filtration rate was 84.5 ml/minute/1.73 m2 (IQR 69.9-99.1). Immediate (day 3 postoperatively), early (month 1) and late (month 24) renal function impairment greater than 25% from baseline was identified in 25.3%, 21.6% and 14.8% of cases, respectively. Female gender and the baseline estimated glomerular filtration rate were independent predictors of immediate, early and late renal function impairment. Age at diagnosis was an independent predictor of immediate and late impairment. Uncontrolled diabetes was an independent predictor of late impairment only. Open and laparoscopic approaches, and pedicle clamping were independent predictors of immediate and early renal function impairment. Overall 58 of 529 patients (11%) experienced postoperative cardiovascular events. Body mass index and late renal function impairment were independent predictors of those events. CONCLUSIONS: Surgically modifiable factors were significantly associated with worse immediate and early functional outcomes after partial nephrectomy while clinically unmodifiable factors affected renal function during the entire followup. Late renal function impairment is an independent predictor of postoperative cardiovascular events.
PURPOSE: We sought to determine the predictors of short-term and long-term renal function impairment after partial nephrectomy. MATERIALS AND METHODS: Clinical data on 769 consecutive patients who underwent partial nephrectomy were prospectively recorded at a total of 19 urological Italian centers from 2009 to 2012 in the RECORd 1 (Italian Registry of Conservative Renal Surgery) Project. We extracted clinical data on 708 of these patients who were alive, free of recurrent disease and with a minimum 2-year functional followup. RESULTS: Of the patients 47.3% underwent open, 36.6% underwent laparoscopic and 16.1% underwent robot-assisted partial nephrectomy. The median baseline estimated glomerular filtration rate was 84.5 ml/minute/1.73 m2 (IQR 69.9-99.1). Immediate (day 3 postoperatively), early (month 1) and late (month 24) renal function impairment greater than 25% from baseline was identified in 25.3%, 21.6% and 14.8% of cases, respectively. Female gender and the baseline estimated glomerular filtration rate were independent predictors of immediate, early and late renal function impairment. Age at diagnosis was an independent predictor of immediate and late impairment. Uncontrolled diabetes was an independent predictor of late impairment only. Open and laparoscopic approaches, and pedicle clamping were independent predictors of immediate and early renal function impairment. Overall 58 of 529 patients (11%) experienced postoperative cardiovascular events. Body mass index and late renal function impairment were independent predictors of those events. CONCLUSIONS: Surgically modifiable factors were significantly associated with worse immediate and early functional outcomes after partial nephrectomy while clinically unmodifiable factors affected renal function during the entire followup. Late renal function impairment is an independent predictor of postoperative cardiovascular events.
Authors: Fabio Crocerossa; Cristian Fiori; Umberto Capitanio; Andrea Minervini; Umberto Carbonara; Savio D Pandolfo; Davide Loizzo; Daniel D Eun; Alessandro Larcher; Andrea Mari; Antonio Andrea Grosso; Fabrizio Di Maida; Lance J Hampton; Francesco Cantiello; Rocco Damiano; Francesco Porpiglia; Riccardo Autorino Journal: Eur Urol Open Sci Date: 2022-03-03
Authors: Jan Ebbing; Felix Menzel; Paolo Frumento; Kurt Miller; Bernhard Ralla; Tom Florian Fuller; Jonas Busch; Justin William Collins; Christofer Adding; Hans Helge Seifert; Peter Ardelt; Christian Wetterauer; Timm Westhoff; Carsten Kempkensteffen Journal: BMC Nephrol Date: 2019-02-04 Impact factor: 2.388