Predictors of renal function after open and robot‐assisted partial nephrectomy: A propensity score‐matched study

Abstract

Objective To investigate parameters predicting short‐ and long‐term renal function after open partial nephrectomy and robot‐assisted partial nephrectomy. Methods Medical records of 896 patients who underwent open partial nephrectomy or robot‐assisted partial nephrectomy from 2004 to 2017 at a single large‐volume institution were retrospectively reviewed. Propensity score matching of open partial nephrectomy and robot‐assisted partial nephrectomy group was carried out with a ratio of 1:1. Postoperative outcomes were compared, and multivariate logistic regression was carried out to identify the parameters influencing acute kidney injury and chronic kidney disease progression. Results No significant differences in preoperative characteristics were observed between the two study groups after matching. Robot‐assisted partial nephrectomy was significantly associated with a longer warm ischemic time (P < 0.001) yet, estimated blood loss, positive surgical margin, rates of major postoperative complications and chronic kidney disease progression were significantly lower in the robot‐assisted partial nephrectomy group (P < 0.001, 0.033, <0.001, <0.001, and 0.005, respectively). Multivariate analysis showed robot‐assisted partial nephrectomy was more favorable than open partial nephrectomy in terms of preserving renal function. Patients with a higher baseline estimated glomerular filtration rate were significantly associated with a greater risk of acute kidney injury (odds ratio 1.036; 95% confidence interval 1.021–1.052; P < 0.001), but a decreased risk of chronic kidney disease progression (odds ratio 0.975; 95% confidence interval 0.955–0.994; P = 0.011). Other independent predictors of chronic kidney disease progression were warm ischemic time (P = 0.025), age (P = 0.035), body mass index (P = 0.041) and diabetes mellitus (P = 0.035). Conclusions Baseline estimated glomerular filtration rate, warm ischemic time and surgery type are independent predictors of both acute kidney injury and chronic kidney disease progression. Robot‐assisted partial nephrectomy is more favorable than open partial nephrectomy for reducing estimated blood loss, positive surgical margin, major postoperative complications and renal function preservation.

Predictive Value of Nephrometry Scores in Nephron-sparing Surgery: A Systematic Review and Meta-analysis

“…Meta-analysis of new-onset CKD was feasible for the RENAL score only, but it did not predict it (p = 0.086; Table 2 and the Supplementary material) [38,41,70]. In terms of renal function variation, continuous [18,70] and categorical RENAL scores [19,63] were independent predictors of an estimated glomerular filtration rate (eGFR) increase (OR: 1.28; 95% CI: 1.07, 1.53; p = 0.006, and OR: 5.64; 95% CI: 2.22, 14.32; p < 0.001, respectively). A pooled analysis was not feasible for the other nephrometry scores because only one study per nephrometry score was available.…”

Perioperative and Long-Term Outcomes of Robot-Assisted Partial Nephrectomy: A Systematic Review

“…On the other hand, Yu et al reported a 5-year RFS of 91.5% for OPN and 94.7% for RAPN (P = .059). 16,17 No significant difference was detected in overall recurrence by the 2 studies that compared RAPN to LPN at 2-year follow-up or the 1 study comparing them at 5 years. 14,18,20 Overall, no significant difference in CSS was detected by surgical approach.…”

“…No RCTs were identified, but 7 observational studies were included in our analysis. Of these studies, 1 compared RAPN to both OPN and LPN, 14 3 compared RAPN to OPN only, [15][16][17] and the remainder compared RAPN to LPN. [18][19][20] Five studies were propensity matched and 2 were multiinstitutional.…”

“…[18][19][20] Five studies were propensity matched and 2 were multiinstitutional. 14,15,[17][18][19] Studies varied in size from 142 to 1800 patients. Most patients were male with an average age between 50 and 70 years old.…”

“…14,18 RAPN was also associated with a lower rate of major complications compared to OPN in 3 out of 4 studies. [15][16][17] Yu et al reported that major complications occurred in 9.2% of OPN procedures compared to only 1.7% of RAPN procedures (P < .001). 17 No significant difference in major complications was reported between RAPN and LPN.…”