2013, Number 1
<< Back Next >>
Rev Invest Clin 2013; 65 (1)
Long-term renal function in patients with renal-cell carcinoma treated surgically: comparison between radical and partial nephrectomy
López-Garibay LA, Cendejas-Gómez JJ, Rodríguez-Covarrubias F, Gómez-Conzatti A, Gabilondo-Navarro F, Sotomayor-de-Zavaleta M
Language: Spanish
References: 30
Page: 7-11
PDF size: 143.72 Kb.
ABSTRACT
Purpose. To compare the renal function (RF) in patients
with renal-cell carcinoma (RCC) treated by radical (RN) or
partial nephrectomy (PN) and to assess the impact of the two
surgical techniques in the glomerular filtration rate (GFR).
Material and methods. We retrospectively analyzed the database
of patients with renal tumors treated surgically. RF
was assessed preoperatively and postoperatively and compared
between both techniques. GFR was estimated using
CKD-EPI formula. Statistical analysis included χ
2,
Student’s t and Friedman tests and a method of logistic regression
(multivariate analysis).
Results. 223 patients with
RCC, who underwent surgery between 1981 and 2010, had
complete information. The mean follow-up was 67.6 ± 49.6
months. There were no significant differences in baseline
characteristics between the RN (n = 196) and PN (N = 27)
groups. After 6 months a GFR ‹ 60 mL/min/1.73 m
2 was detected
in 63% vs. 29% (p = 0.0007), after 12 months in 64%
vs. 33% (p = 0.002) and after 60 months in 53% vs. 40% (p =
0.2) of the patients in RN and PN groups, respectively. The
absolute decrease in GFR was 22% after RN and 17% after
PN. In the multivariate analysis, preoperative GFR and type
of surgery were associated with an impairment of RF after 6
and 12 months.
Conclusion. RN results in a more important
impairment of RF after 6 and 12 months. At 60 months,
patients treated with PN maintain a mean GFR › 60 mL/
min/1.73 m
2.
REFERENCES
Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2007. CA Cancer J Clin 2007; 57: 43-66.
Chow WH, Devesa SS, Warren JL, et al. Rising incidence of renal cell cancer in the United States. JAMA 1999; 281: 1628-31.
Hollingsworth JM, Miller DC, Daignault S, et al. Rising incidence of small renal masses: a need to reassess treatment effect. J Natl Cancer Inst 2006; 98: 1331-4.
Ljungberg B, Cowan NC, Hanbury DC, et al. EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 2010; 58: 398-406.
Antoniewicz AA, Poletajew S, Borówka A, et al. Renal function and adaptive changes in patients after radical or partial nephrectomy. Int Urol Nephrol 2011. En prensa. DOI: 10.1007/ s11255-011-0058-z.
Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004; 351: 1296-305.
Huang WC, Elkin EB, Levey AS, et al. Partial nephrectomy versus radical nephrectomy in patients with small renal tumors: is there a difference in mortality and cardiovascular outcomes? J Urol 2009; 181: 55-62.
Huang WC, Levey AS, Serio AM, et al. Chronic kidney disease after nephrectomy in patients with renal cortical tumors: a retrospective cohort study. Lancet Oncol 2006; 7: 735-40.
Rodríguez-Covarrubias F, Gabilondo B, Borgen JL, et al. Partial nephrectomy for renal tumors using selective parenchymal clamping. Int Urol Nephrol 2007; 39: 43-46.
Thompson RH, Siddiqui S, Lohse CM, et al. Partial versus radical nephrectomy for 4 to 7 cm renal cortical tumors. J Urol 2009; 182: 2601-06.
McKiernan J, Simmons R, Katz J, et al. Natural history of chronic renal insufficiency after partial and radical nephrectomy. Urology 2002; 59: 816-20.
Gómez-Alvarado O, Rodríguez-Covarrubias F, Sotomayor M, et al. Factores pronósticos en carcinoma de células renales tratado quirúrgicamente: análisis de una cohorte de 345 casos. Rev Invest Clin 2011; 63: 12-17.
Lesage K, Joniau S, Fransis K, et al: Comparison between open partial and radical nephrectomy for renal tumors: perioperative outcome and health-related quality of life. Eur Urol 2007; 51: 614-20.
Lee CT, Katz J, Shi W, et al. Surgical management of renal tumor 4 cm or less in contemporary cohort. J Urol 2000; 163: 730-6.
Clark AT, Breau RH, Morash C, et al. Preservation of renal function following partial or radical nephrectomy using 24- hour creatinine clearance. Eur Urol 2008; 54: 143-9.
Weigth CJ, Larson BT, Fergany AF, et al. Nephrectomy induced chronic renal insufficiency is associated with increased risk of cardiovascular death and death from any cause in patients with localized cT1b renal masses. J Urol 2010; 183: 1317-23.
Levey AS, Eckardt KU, Tsukamoto Y, et al. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2005; 67: 2089-100.
Levey AS, Coresh J, Balk E, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification and stratification. Ann Intern Med 2003; 139: 137-47.
Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16: 31-41.
Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999; 130: 461-70.
Levey AS, Greene T, Kusek J, et al. A simplified equation to predict glomerular filtration rate from serum creatinine (abstract). J Am Soc Nephrol 2000; 11: 155A.
Poggio ED, Wang X, Greene, et al. Performance of the modification of diet in renal disease and Cockcroft-Gault equations in the estimation of GFR in health and in chronic kidney disease. J Am Soc Nephrol 2005; 16: 459-66.
Froissart M, Rossert J, Jacquot C, et al. Predictive performance of the modification of diet in renal disease and Cockcroft- Gault equations for estimating renal function. J Am Soc Nephrol 2005; 16: 763-73.
Lin J, Knigth EL, Hogan ML, et al. A comparison of prediction equations for estimating glomerular filtration rate in adults without kidney disease. J Am Soc Nephrol 2003; 14: 2573-80.
Rule AD, Larson TS, Bergstralh EJ, et al. Using serum creatinine to estimate glomerular filtration rate: accuracy in good health and in chronic kidney disease. Ann Intern Med 2004; 141: 929-37.
Stevens LA, Coresh J, Greene T, et al. Assessing kidney function: measured and estimated glomerular filtration rate. N Engl J Med 2006; 354: 2473-83.
Stevens LA, Schmid CH, Greene T, et al. Comparative performance of the CKD Epidemiology Collaboration (CKD-EPI) and the Modification of Diet in Renal Disease (MDRD) Study equations for estimating GFR levels above 60 mL/min/1.73m2. Am J Kidney Dis 2010; 56: 486-95.
López Suárez A, Beltrán Robles M, Elvira González J, et al. Comparison of the MDRD and CKD-EPI equations to estimate glomerular filtration rate in the general population. Med Clin (Barc) 2010; 134: 617-23.
Lane BR, Demirjian S, Weight CJ, et al. Performance of the chronic kidney disease-epidemiology study equations for estimating glomerular filtration rate before and after nephrectomy. J Urol 2010; 183: 896-902.
Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150: 604-12.