The Impact of Body Mass Index on Renal Functional Outcomes Following Minimally Invasive Partial Nephrectomy

Richards, Kyle A.; Negron, Edris; Cohn, Joshua A.; Steinberg, Zoe; Eggener, Scott E.; Shalhav, Arieh L.

doi:10.1089/end.2014.0360

Cited by 11 publications

(6 citation statements)

References 27 publications

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“…Conversely, in a minimally invasive cohort, Richards and colleagues found obesity to be linked with new onset chronic kidney disease stage 3 and a greater decline in eGFR-findings not supported by our data. 30 Our findings must be understood in the context of the limitations of this retrospective cohort. Although selection for robotic surgery would naturally be a source of bias, it is worth noting that this cohort reflects a wide range of BMIs that closely resembles the American population.…”

Section: Figmentioning

confidence: 86%

The Impact of Obesity in Patients Undergoing Robotic Partial Nephrectomy

Rosen

Kannappan

Kim

et al. 2019

Journal of Endourology

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Introduction: As the prevalence of obesity increases worldwide, an increasing proportion of surgical candidates have an elevated body mass index (BMI), with associated metabolic syndrome. Yet there exists limited evidence regarding the effect of elevated BMI on surgical outcomes in robotic surgeries. We examined whether obese patients had worse perioperative outcomes and postoperative renal function after robotic partial nephrectomies (RPNs). Materials and Methods: We performed a multi-institutional analysis of 1770 patients who underwent RPNs between 2008 and 2015, allowing time for the data set to mature. Associations between BMI, as a continuous and categorical variable, and perioperative outcomes, acute kidney injury (AKI, >25% reduction in estimated glomerular filtration rate [eGFR]) at discharge, and change in eGFR per month were analyzed. AKI and eGFR were evaluated using multivariable logistic and linear regression models adjusted for confounders, including age, Charlson comorbidity index, tumor size, and the identity of the surgeon. Results: In total 45.2% (n = 529) of patients were found to be obese, with a greater prevalence of hypertension and diabetes in overweight and obese patients. Obese patients were more likely to have malignant tumors (>77% vs 68%, p < 0.001) and trended toward having larger tumors (3.0 cm vs 2.8 cm; p = 0.061). Heavier patients required longer operative times (166-196 minutes vs 155 minutes; p < 0.001), although equivalent warm ischemia times (p = 0.873). Obesity did not correlate with an increased complication rate (p > 0.05). On multivariable analysis, obesity (odds ratio [OR] = 1.81; p = 0.031), male sex (OR = 1.54; p = 0.028), and larger tumor size (OR = 1.23; p < 0.001) were associated with a significant increase in the likelihood of AKI at discharge. BMI above normal weight was not associated with greater eGFR decline per month post-RPN. Conclusions: Obesity was associated with equivalent perioperative outcomes and long-term renal function. Further research is warranted into how obesity and metabolic syndrome may foster a more aggressive tumor environment. RPN appears to be an equally safe operative option for patients regardless of obesity status.

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Section: Figmentioning

confidence: 86%

The Impact of Obesity in Patients Undergoing Robotic Partial Nephrectomy

Rosen

Kannappan

Kim

et al. 2019

Journal of Endourology

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“…Numerous authors have demonstrated this correlation. Richards et al [24] showed that increasing BMI was associated with significant absolute reduction in eGFR at 1 year (0.38 mL/ min/1.73 m 2 reduction in eGFR per 1 kg/m 2 increase in BMI, p = 0.009) after partial nephrectomy. Nozaki et al [25] also showed that the deterioration of renal function Urol Int 2018;101:400-408 DOI: 10.1159/000493763 after donor nephrectomy was negatively correlated with BMI.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Renal Function after Radical Surgery for Upper Tract Urothelial Carcinoma versus Renal Cell Carcinoma: Propensity Score Matching

Tae

Kwak

et al. 2018

Urol Int

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Objectives: To compare renal function after radical nephrectomy for renal cell carcinoma (RCC) and for upper tract urothelial carcinoma (UTUC). Method: Data from 1,236 patients with RCC or UTUC treated surgically from 2000 to 2013 were enrolled. The estimated glomerular filtration rate (eGFR) was calculated preoperatively and postoperatively at 12, 24, 36, 48, and 60 months. A multivariate logistic regression was used to determine independent factors for a decrease in eGFR to < 60 mL/min/1.73 m² and end-stage renal disease. Result: After propensity score matching, a total of 554 patients were included. During follow-up for 5 years, there was statistically significant difference in eGFR between 2 groups. And there was a statistically significant difference in the number of patients developing impaired renal function between the 2 groups (UTUC 73.3 vs. RCC 66.1%, p = 0.039). Multivariate analysis showed that old age (OR 3.957, p < 0.001), UTUC (OR 1.838, p = 0.006), BMI (OR 2.463, p = 0.001) and a baseline eGFR (OR 0.976, p = 0.001) were independent risk factors for postoperative impaired renal function. Conclusion: Patients with UTUC had worse baseline eGFR, old age, comorbidities than RCC patients. Even after adjusting by PS matching, UTUC patients had lower postoperative eGFR and higher rates of CKD development than RCC patients.

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“…To preserve nephrons and, in turn, preserve renal function, partial nephrectomy has become the preferred option to radical nephrectomy when removing small renal tumors [ 14 , 17 - 19 ]. Although the more traditional open partial nephrectomy (OPN) is still performed, many have opted for minimally invasive surgical techniques, such as laparoscopic partial nephrectomy (LPN) or robotic partial nephrectomy (RPN), because of their shorter hospital stays and operating times [ 20 ]. With increased precision, dexterity, and 3D capabilities, RPNs are more commonly performed than OPNs or LPNs [ 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

“…Because of the increased likelihood of postoperative complications, both medical and surgical techniques must be assessed to establish the best practice for patients with obesity. Although increased BMI adds another level of difficulty for physicians performing partial nephrectomies, the procedure is considered especially advantageous in this population [ 20 , 23 ]. RPNs have become a more favorable approach in the general population; however, there is still controversy regarding the most efficacious surgical technique in patients with obesity.…”

Section: Introductionmentioning

confidence: 99%

Short-Term and Long-Term Renal Outcomes in Patients With Obesity After Minimally Invasive Versus Open Partial Nephrectomy for the Treatment of Renal Cancer: Retrospective Study

Roses¹,

Stone²,

Stahr³

et al. 2022

JMIR Form Res

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Background Obesity is significantly associated with renal cell carcinoma. Surgery is the preferred treatment for demarcated lesions of renal cell carcinoma; however, obesity increases the complexity of surgical outcomes. Minimally invasive surgical techniques are preferred over open partial nephrectomy (OPN), but controversy remains regarding the most efficacious technique in patients with obesity. Objective This study aims to determine whether minimally invasive partial nephrectomy (MIPN) or OPN better preserves renal function and investigate short- and long-term renal outcomes in patients with obesity undergoing a partial nephrectomy. Methods We conducted a retrospective chart review of 242 adult patients aged ≥18 years who underwent MIPN or OPN between January 1, 2005, and December 31, 2016, at the University of Arkansas for Medical Sciences. Using creatinine as a measure of kidney function, patients’ preoperative levels were compared with their postoperative levels in 2-time frames: short (3-6 months postsurgery) or long (>6 months). The primary outcome was the change in creatinine values from preoperative to >6 months postoperatively in patients with obesity. Secondary outcomes included the change in creatinine values from preoperative to 3 to 6 months postoperatively in patients with obesity who underwent MIPN versus OPN. We also analyzed the creatinine values of nonobese patients (BMI <30) who underwent partial nephrectomy using the same time frames. Unconditional logistic regression was used to estimate crude and multivariable-adjusted odds ratios (ORs) and 95% CI to observe associations between surgery type and changes in creatinine values from while stratifying for obesity. Results A total of 140 patients were included in the study, of whom 75 were obese and 65 were nonobese. At >6 months after MIPN (n=20), the odds of patients with obesity having a decrease or no change in creatinine values was 1.24 times higher than those who had OPN (n=13; OR 1.24, 95% CI 0.299-6.729; P=.80). At 3 to 6 months after MIPN (n=27), the odds were 0.62 times lower than those after OPN (n=17; OR 0.62, 95% CI 0.140-2.753; P=.56). In the nonobese group, at 3 to 6 months after undergoing minimally invasive surgery (n=18), the odds of having a decrease or no change in creatinine values was 4.86 times higher than those who had open surgery (n=21; OR 4.86, 95% CI 1.085-21.809; P=.04). At more than 6 months after MIPN (n=14), the odds were 4.13 times higher than those after OPN (n=11; OR 4.13, 95% CI 0.579-29.485; P=.16). Conclusions We observed a nonstatistically significant preservation of renal function in patients with obesity who underwent OPN at 3 to 6 months postoperatively. Conversely, after 6 months, the same was true for MIPN, indicating the long-term benefit of MIPN. In the nonobese group, MIPN was favored over OPN.

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The Impact of Body Mass Index on Renal Functional Outcomes Following Minimally Invasive Partial Nephrectomy

Cited by 11 publications

References 27 publications

The Impact of Obesity in Patients Undergoing Robotic Partial Nephrectomy

The Impact of Obesity in Patients Undergoing Robotic Partial Nephrectomy

Comparison of Renal Function after Radical Surgery for Upper Tract Urothelial Carcinoma versus Renal Cell Carcinoma: Propensity Score Matching

Short-Term and Long-Term Renal Outcomes in Patients With Obesity After Minimally Invasive Versus Open Partial Nephrectomy for the Treatment of Renal Cancer: Retrospective Study

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