Umberto Capitanio1, Alessandro Larcher2, Francesco Cianflone3, Francesco Trevisani3, Alessandro Nini3, Alexandre Mottrie4, Andrea Mari5, Riccardo Campi5, Riccardo Tellini6, Alberto Briganti3, Alessandro Veccia6, Hendrik Van Poppel7, Marco Carini5, Claudio Simeone6, Andrea Salonia3, Andrea Minervini5, Alessandro Antonelli6, Francesco Montorsi3, Roberto Bertini3. 1. Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy. Electronic address: capitanio.umberto@hsr.it. 2. Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy; ORSI Academy, Melle, Belgium; Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium. 3. Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy. 4. ORSI Academy, Melle, Belgium; Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium. 5. Clinica Urologica I, Azienda Ospedaliera Universitaria Careggi, Università degli studi di Firenze, Firenze, Italy. 6. Department of Urology, Università degli studi e Spedali Civili di Brescia, Brescia, Italy. 7. Department of Urology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
Abstract
BACKGROUND: Despite better renal function following nephron-sparing surgery (NSS) relative to radical nephrectomy (RN), there is no consensus with respect to the long-term sequelae associated with surgery. OBJECTIVE: To investigate the effect of surgery and the temporal pattern of two different cardiovascular event (CVe) categories after NSS versus RN. DESIGN, SETTING, AND PARTICIPANTS: We collected data of 898 patients with cT1-2 N0 M0 renal mass and no history of CVe treated with NSS versus RN. CVe categories were dichotomised in (1) de novo hypertension (HT) and (2) other major cardiovascular events (MCEs). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Multivariable competing regression analyses (MVAs) tested the adjusted effect of surgery type on each CVe category. RESULTS AND LIMITATIONS: Among patients treated with RN, 38% of HT events occurred immediately after surgery. Conversely, in NSS counterparts, the onset of HT was diluted over the years after surgery (10% of HT events in the first 6 mo). When an MCE was considered, an increasing long-term time-dependent prevalence of the outcome was observed in both groups, with no statistically significantly difference between NSS and RN. At MVA, RN was associated with a higher HT risk (hazard ratio [HR] 2.89; p=0.006) than but a similar MCE risk (HR 0.85; p=0.6) to NSS. CONCLUSIONS: Relative to RN, NSS showed an independent protective effect on HT but not on MCEs. In patients with no history of preoperative HT or MCEs, the onset of HT after RN is a very early event, due probably to the acute loss of renal parenchyma. This is not the case for the other cardiovascular morbidity, which develops in the long-term period, regardless of the type of surgery performed. PATIENT SUMMARY: In renal cancer patients without a medical history of cardiopathy, preserving healthy kidney tissue at surgery is associated with a decreased risk of developing postoperative hypertension.
BACKGROUND: Despite better renal function following nephron-sparing surgery (NSS) relative to radical nephrectomy (RN), there is no consensus with respect to the long-term sequelae associated with surgery. OBJECTIVE: To investigate the effect of surgery and the temporal pattern of two different cardiovascular event (CVe) categories after NSS versus RN. DESIGN, SETTING, AND PARTICIPANTS: We collected data of 898 patients with cT1-2 N0 M0 renal mass and no history of CVe treated with NSS versus RN. CVe categories were dichotomised in (1) de novo hypertension (HT) and (2) other major cardiovascular events (MCEs). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Multivariable competing regression analyses (MVAs) tested the adjusted effect of surgery type on each CVe category. RESULTS AND LIMITATIONS: Among patients treated with RN, 38% of HT events occurred immediately after surgery. Conversely, in NSS counterparts, the onset of HT was diluted over the years after surgery (10% of HT events in the first 6 mo). When an MCE was considered, an increasing long-term time-dependent prevalence of the outcome was observed in both groups, with no statistically significantly difference between NSS and RN. At MVA, RN was associated with a higher HT risk (hazard ratio [HR] 2.89; p=0.006) than but a similar MCE risk (HR 0.85; p=0.6) to NSS. CONCLUSIONS: Relative to RN, NSS showed an independent protective effect on HT but not on MCEs. In patients with no history of preoperative HT or MCEs, the onset of HT after RN is a very early event, due probably to the acute loss of renal parenchyma. This is not the case for the other cardiovascular morbidity, which develops in the long-term period, regardless of the type of surgery performed. PATIENT SUMMARY: In renal cancerpatients without a medical history of cardiopathy, preserving healthy kidney tissue at surgery is associated with a decreased risk of developing postoperative hypertension.
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