Will the kidney function be reduced in patients with renal cell carcinoma following laparoscopic partial nephrectomy? Baseline eGFR, warm ischemia time, and RENAL nephrometry score could tell

摘要

ObjectivesTo describe the natural history of kidney function following partial nephrectomy (PN) for patients with renal cell carcinoma (RCC), and to identify independent predictors of whether patients with RCC will retain renal function unchangeable or even increased and develop functional impairment of ≧25% post-PN. Patients and methodsWe performed a retrospective analysis of 337 cases involving patients diagnosed with RCC of pT1-2N0M0 who underwent laparoscopic PN, the primary endpoints included the stabilization or increase in postoperative estimated glomerular filtration rate (eGFR) compared to the preoperative level and eGFR impairment of ≧25% following surgery. We plotted the trajectory of each patient's eGFR measurement starting from their first postoperative day to the last follow-up time post-PN and used moving average method to look at trends of eGFR changing. A logistic regression model was then applied to identify associations between clinical and surgical characteristics with eGFR outcomes. ResultsPatients were of an average age of 51.4 years and all were Chinese descent. The cohort was also primarily male (69.1%). One hundred ninety seven (58.5%) had eGFR ≧90 ml/min/1.73 m2, while 140 (41.5%) had an eGFR of 60 to 90 ml/min/1.73 m2prior to the operation. All patients underwent minimally invasive PN with warm ischemia, with 64.1% (216/337) receiving laparoscopic surgery, and 35.9% (121/337) receiving robot-assisted laparoscopic surgery. On average, patients experienced a mean eGFR decrease of 23.8% immediately post-PN, followed by a slight increase and stabilization, with a mean 15.5% decline after 1 year. Twenty four percent (81/337) experienced GFR impairment of ≧25% over a median 10.0-month follow-up time period, while 29.1% (99/337) patients retained eGFR unchangeable or increased post-PN. And higher preoperative eGFR, longer warm ischemia time, and more complexity lesions (higher renal nephrometry score ) were found to be independently associated with higher chance of functional impairment of ≧25% and lower chance of eGFR stabilization post-PN. ConclusionAlthough, majority of patients experienced decline of renal function post-PN, functional outcomes of eGFR unchangeable and increased were also seen, and baseline total eGFR, WIT as well as RENAL nephrometry score were determined to be independent predictors of those renal functional outcomes.