Should partial nephrectomy be considered “elective” in patients with stage 2 chronic kidney disease? A comparative analysis of functional and survival outcomes after radical and partial nephrectomy

Hamilton, Zachary; Capitanio, Umberto; Lane, Brian R.; Larcher, Alessandro; Yim, Kendrick; Dey, Sumi; Cotta, Brittney; Meagher, Margaret; Kirmiz, Samer; Bezinque, Adam; Eldefrawy, Ahmed; Bradshaw, Aaron; Ryan, Stephen; Carenzi, Cristina; Wan, Fang; Proudfoot, James; Montorsi, Francesco; Derweesh, Ithaar

doi:10.1007/s00345-019-02650-9

Cited by 16 publications

(13 citation statements)

References 34 publications

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“…Multivariate logistic regression analysis indicated that RN was an independent prognostic factor for new-onset CKD (OR = 3.07; 95% CI, 1.03–9.79; p = 0.04), which indicates that the renal function of patients with renal cancer should be assessed before surgery. If the patient’s CKD stage reaches stage 2, especially stage 2b, when PN is feasible, the strategy of nephron preservation surgery should be considered ( 37 ). A similar study was conducted by Chung et al ( 38 ), the results of which demonstrated that compared to RN, PN had a more favorable effect on the OS of patients with renal dysfunction (CKD stage I and II) before surgery.…”

Section: Discussionmentioning

confidence: 99%

Partial Nephrectomy Versus Radical Nephrectomy for Clinical T2 or Higher Stage Renal Tumors: A Systematic Review and Meta-Analysis

et al. 2021

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ObjectiveThe choice of surgical method for clinically diagnosed T2 or higher stage kidney cancer remains controversial. Here, we systematically reviewed and collected published comparative studies on renal function, oncologic outcomes, and perioperative results of partial nephrectomy (PN) versus radical nephrectomy (RN) for larger renal tumors (T2 and above), and performed a meta-analysis.Evidence AcquisitionFollowing searches of PubMed, Web of Science, and Embase, the original studies on PN vs. RN in the treatment of T2 renal cancer were screened through strict inclusion and exclusion criteria. RevMan 5.4 was used for data analysis of the perioperative results, renal function, and oncologic outcomes of the two surgical methods for T2 renal tumor therapy. The weighted mean difference was used as the combined effect size for continuous variables, while the odds ratio (OR) or risk ratio (RR) was used as the combined effect size for binary variables. Both variables used a 95% confidence interval (CI) to estimate statistical accuracy. In cases with low heterogeneity, the fixed-effects model was used to pool the estimated value; otherwise, the random-effects model was used when significant heterogeneity was detected.ResultsFifteen retrospective studies including 5,056 patients who underwent nephrectomy (PN: 1975, RN: 3081) were included. The decline in estimated GFR (eGFR) after PN was lower than RN [(MD: −11.74 ml/min/1.73 m2; 95% CI: −13.15, −10.32; p < 0.00001)]. The postoperative complication rate of PN was higher than that of PN (OR: 2.09; 95% CI: 1.56, 2.80; p < 0.00001)], and the postoperative overall survival (OS) of PN was higher than that of RN (HR: 0.77; 95% CI: 0.65, 0.90; p = 0.002), and tumor recurrence (RR, 0.69; 95% CI: 0.53, 0.90; p = 0.007). No obvious publication bias was found in the funnel chart of the OS rates of the two groups of patients.ConclusionsPN is beneficial for patients with T2 renal tumors in terms of OS and renal function protection. However, it is also associated with a higher risk of surgical complications.

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Section: Discussionmentioning

confidence: 99%

Partial Nephrectomy Versus Radical Nephrectomy for Clinical T2 or Higher Stage Renal Tumors: A Systematic Review and Meta-Analysis

et al. 2021

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“…Additionally, we found a greater risk of NCM in patients with elevated preoperative CRP and patients with new CKD Stage 3b (eGFR of <45 mL/min/1.73 m 2 ) after PN or RN. The association of worsened overall survival (OS) or NCM in patients with baseline or de novo CKD Stage 3b after surgery for RCC has been previously demonstrated [15,20–22]. Pettus et al .…”

Section: Discussionmentioning

confidence: 99%

“…The relationship between RCC and metabolic syndrome is an important area of future research as the worldwide incidence of obesity is ever increasing. [15,[20][21][22]. Pettus et al [21] assessed 1479 patients who underwent PN or RN over a 10-year period and found that patients with a baseline eGFR of <45 and <30 mL/min/1.73 m 2 had a significantly reduced OS (HR 1.5, P < 0.003; and HR 2.8, P < 0.001, respectively).…”

Section: Discussionmentioning

confidence: 99%

Elevated preoperative C‐reactive protein is associated with renal functional decline and non‐cancer mortality in surgically treated renal cell carcinoma: analysis from the INternational Marker Consortium for Renal Cancer (INMARC)

Cotta¹,

Meagher²,

Patil

et al. 2020

BJU International

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Objective To investigate association of preoperative C‐reactive protein (CRP) and non‐cancer mortality (NCM) in a cohort of patients undergoing surgery for localised renal cell carcinoma (RCC). Patients and Methods Retrospective multicentre analysis of patients surgically treated for clinical Stage 1–2 RCC from 2006 to 2017, excluding all cases of cancer‐specific mortality. Descriptive analyses were obtained between the pre‐treatment normal‐CRP (≤5 mg/L) and elevated‐CRP (>5 mg/L) groups. The primary outcome was NCM. The secondary outcomes included progression to de novo chronic kidney disease Stages 3–4 (estimated glomerular filtration rate [eGFR] of <60, <45, and <30 mL/min/1.73 m2). Multivariable analyses (MVA) were performed to assess for risk factors associated with functional decline and NCM, and Kaplan–Meier analysis was used to obtain survival estimates for outcomes. Results A total of 1987 patients who underwent radical or partial nephrectomy were analysed (normal‐CRP group, n = 963; elevated‐CRP group, n = 1024). Groups were similar in age (59 vs 60 years, P = 0.079). An elevated CRP was more frequent in males (36.8% vs 27.8%, P < 0.001), African‐Americans (22.6% vs 2.9%, P < 0.001), and in those with a higher median body mass index (30 vs 25 kg/m2, P < 0.001) and larger median tumour size (4.5 vs 3.3 cm, P < 0.001). On MVA, an elevated CRP was independently associated with development of de novo eGFR of <60 mL/min/1.73 m2 (hazard ratio [HR] 1.32, P = 0.015), <45 mL/min/1.73 m2 (HR 1.41, P = 0.023) and <30 mL/min/1.73 m2 (odds ratio 2.23, P < 0.001). The MVA for factors associated with NCM demonstrated increasing age (HR 1.06, P < 0.001), preoperative elevated CRP (HR 2.18, P < 0.001) and an eGFR of <45 mL/min/1.73 m2 (HR 1.16; P = 0.021) as independent risk factors. Kaplan–Meier analysis revealed significantly higher 5‐year NCM in the elevated‐CRP group vs the normal‐CRP group (98% vs 80%, P < 0.001). Conclusions Pre‐treatment elevated CRP was independently associated with both progressive renal functional decline and NCM in patients undergoing surgery for Stage 1–2 RCC. Patients with elevated CRP and Stage 1 and 2 RCC may be considered as having indication for nephron‐sparing strategies, which may be prioritised if oncologically appropriate.

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“…Breda bepleitte per definitie een partiële nefrectomie te verrichten als dit technisch mogelijk is, met het oog op nierfunctiebehoud. Bij de radicale nefrectomie (RN) ontwikkelt 10-15% van de patiënten chronisch nierfalen graad 3 (CKD3; eGFR < 45 ml/min/1,73 m), met een negatief effect op de overlevingsduur [3]. Dr. Breda besprak onder andere een recente studie van Bradshaw et al, waarin de RAPN vergeleken werd met MIS-RN bij cT2a-niertumoren [4].…”

Section: Niersparende Chirurgie: Wegen De Voordelen Van Partiële Nefrectomie Op Tegen De Additionele Risico's?unclassified

Controverses, complicaties en nieuwe technieken in nierchirurgie

Vries¹,

Zondervan

Beerlage³

2020

Tijdschr Urol

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Samenvatting Sinds de introductie van minimaal-invasieve chirurgie (MIS) in de jaren ‘90 van de vorige eeuw heeft de nierchirurgie een enorme vlucht genomen. Na de eerste laparoscopische nefrectomie in 1990 door Ralph Clayman volgde in 2001 de eerste robotgeassisteerde nefrectomie door Bertrand Guillonneau. Inmiddels wordt in Nederland de nierchirurgie grotendeels minimaal-invasief uitgevoerd.

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Should partial nephrectomy be considered “elective” in patients with stage 2 chronic kidney disease? A comparative analysis of functional and survival outcomes after radical and partial nephrectomy

Cited by 16 publications

References 34 publications

Partial Nephrectomy Versus Radical Nephrectomy for Clinical T2 or Higher Stage Renal Tumors: A Systematic Review and Meta-Analysis

Partial Nephrectomy Versus Radical Nephrectomy for Clinical T2 or Higher Stage Renal Tumors: A Systematic Review and Meta-Analysis

Elevated preoperative C‐reactive protein is associated with renal functional decline and non‐cancer mortality in surgically treated renal cell carcinoma: analysis from the INternational Marker Consortium for Renal Cancer (INMARC)

Controverses, complicaties en nieuwe technieken in nierchirurgie

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