Reply from Authors re: Christopher J. Weight, R. Houston Thompson. the Role of Ischemia, or the Lack Thereof, during Partial Nephrectomy. Eur Urol 2012;61:75-76

摘要

Over the last decade we have witnessed a plethora of scientific work regarding renal functional preservation in the setting of a renal mass. This topic has become increasingly important for a couple of reasons: Decreased renal function has been associated with diminished survival and increased morbidity in the general medical population, and partial nephrectomy (PN) has equivalent cancer control compared with radical nephrectomy (RN) and better preserves renal function.A hypothesis arose suggesting that renal function preservation associated with PN might be associated with better survival in patients with renal masses. Initial comparisons of cohorts of patients treated by either RN or PN did show improved survival for those treated by PN , but in these nonrandomized cohorts, it was unclear whether this result was merely due to selection bias or other confounding variables. In a recently reported randomized trial comparing PN and RN, a survival advantage was not observed for PN; however, glomerular filtration rates (GFRs) were not reported, and the study was closed due to poor accrual after 541 of the planned 1300 patients were accrued.