Sudhir Isharwal1, Wenda Ye2, Alice Wang3, Joseph Abraham2, Joseph Zabell1, Wen Dong4, Jitao Wu5, Chalairat Suk-Ouichai6, Elvis R Caraballo1, Tianming Gao7, Steven C Campbell8. 1. Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio. 2. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio. 3. Department of Urology, Vanderbilt University, Nashville, Tennessee. 4. Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China. 5. Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio; Department of Urology, Yantai Yuhuangding Hospital, Yantai, China. 6. Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio; Division of Urology, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand. 7. Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio. 8. Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: campbes3@ccf.org.
Abstract
PURPOSE: Parenchymal mass preservation, and ischemia type and/or duration can influence functional recovery after partial nephrectomy. Some groups have hypothesized that relevant comorbidities may also impact nephron stability and functional recovery but this has not been adequately investigated. MATERIALS AND METHODS: At our center 405 patients treated with partial nephrectomy from 2007 to 2015 had the necessary data to determine the function and parenchymal mass preserved in the ipsilateral kidney. Comorbidities potentially associated with renal functional status were reviewed, including various degrees of hypertension, diabetes, cardiovascular disease, obesity, smoking status and related medications. Multivariable linear regression was done to assess factors associated with functional recovery, defined as the percent of preserved ipsilateral glomerular filtration rate. RESULTS: Median tumor size was 3.5 cm and the median R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of tumor to collecting system or sinus, anterior/posterior, location relative to polar lines and tumor touching main renal artery or vein) score was 8. Warm and cold ischemia were done in 264 (65%) and 141 patients for a median duration of 21 and 27 minutes, respectively. The median preserved ipsilateral glomerular filtration rate was 79%. Patient age, comorbidity index, hypertension and proteinuria were each associated with the preoperative glomerular filtration rate (all p <0.01). On univariable and multivariable analyses the preserved parenchymal mass, and ischemia type and duration were significantly associated with functional recovery (all p <0.001). On univariable analysis of comorbidities only hypertension was significantly associated with functional recovery. However, on multivariable analysis none of the analyzed comorbidities were associated with functional recovery. CONCLUSIONS: Recovery of function after partial nephrectomy depends primarily on parenchymal mass preservation and ischemia characteristics. Comorbidities failed to be associated with functional outcomes. Comorbidities can impact function, leading to surgery, and may influence long-term functional stability. However, our data suggest that they do not influence short-term recovery after partial nephrectomy.
PURPOSE: Parenchymal mass preservation, and ischemia type and/or duration can influence functional recovery after partial nephrectomy. Some groups have hypothesized that relevant comorbidities may also impact nephron stability and functional recovery but this has not been adequately investigated. MATERIALS AND METHODS: At our center 405 patients treated with partial nephrectomy from 2007 to 2015 had the necessary data to determine the function and parenchymal mass preserved in the ipsilateral kidney. Comorbidities potentially associated with renal functional status were reviewed, including various degrees of hypertension, diabetes, cardiovascular disease, obesity, smoking status and related medications. Multivariable linear regression was done to assess factors associated with functional recovery, defined as the percent of preserved ipsilateral glomerular filtration rate. RESULTS: Median tumor size was 3.5 cm and the median R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of tumor to collecting system or sinus, anterior/posterior, location relative to polar lines and tumor touching main renal artery or vein) score was 8. Warm and cold ischemia were done in 264 (65%) and 141 patients for a median duration of 21 and 27 minutes, respectively. The median preserved ipsilateral glomerular filtration rate was 79%. Patient age, comorbidity index, hypertension and proteinuria were each associated with the preoperative glomerular filtration rate (all p <0.01). On univariable and multivariable analyses the preserved parenchymal mass, and ischemia type and duration were significantly associated with functional recovery (all p <0.001). On univariable analysis of comorbidities only hypertension was significantly associated with functional recovery. However, on multivariable analysis none of the analyzed comorbidities were associated with functional recovery. CONCLUSIONS: Recovery of function after partial nephrectomy depends primarily on parenchymal mass preservation and ischemia characteristics. Comorbidities failed to be associated with functional outcomes. Comorbidities can impact function, leading to surgery, and may influence long-term functional stability. However, our data suggest that they do not influence short-term recovery after partial nephrectomy.
Authors: Andrew G McIntosh; Daniel C Parker; Brian L Egleston; Robert G Uzzo; Mohammed Haseebuddin; Shreyas S Joshi; Rosalia Viterbo; Richard E Greenberg; David Y T Chen; Marc C Smaldone; Alexander Kutikov Journal: BJU Int Date: 2019-06-30 Impact factor: 5.588
Authors: Rocco Simone Flammia; Umberto Anceschi; Antonio Tufano; Gabriele Tuderti; Maria Consiglia Ferriero; Aldo Brassetti; Andrea Mari; Fabrizio Di Maida; Andrea Minervini; Ithaar H Derweesh; Umberto Capitanio; Alessandro Larcher; Francesco Montorsi; Daniel D Eun; Jennifer Lee; Lorenzo G Luciani; Tommaso Cai; Gianni Malossini; Alessandro Veccia; Riccardo Autorino; Cristian Fiori; Francesco Porpiglia; Michele Gallucci; Costantino Leonardo; Giuseppe Simone Journal: J Clin Med Date: 2022-02-25 Impact factor: 4.241