Abstract
Objective: To find out the pattern of change in post-operative renal function in patients who underwent radical nephrectomy for renal cell carcinoma.
Patients and Methods: A retrospective review of histological and biochemical findings in all patients who underwent RN for RCC over a period of 4 years was done. Study group comprised of 106 cases. Estimated glomerular filtration rate (eGFR) was calculated pre-operatively, 2 weeks and 3 months postoperatively and 6 monthly thereafter with a median follow up period of 24 months. Clinical variables that were evaluated included the age, sex, co-morbidities particularly diabetes mellitus (DM) and hypertension, tumor size, tumor stage, and preoperative estimated GFR(eGFR).
Results: The incidence of a moderate decrease in GFR after RN was 44 (48.88%)..Patients with pT1a tumors had significantly higher mean baseline pre-operative eGFR compared to other T stages and the eGFR decline was also highest for T1a cases. There was significant negative correlation between tumor size and pre-operative eGFR. Age, DM, preop GFR, tumor size and tumor stage were found to be strong determinants of decline in GFR postoperatively.
Conclusions: eGFR decline seems to be more for those with small renal tumors and they might derive the most benefit from NSS.
Keywords: Renal function, Renal cell Carcinoma, Radical Nephrectomy, Glomerular filtration rate.
References
- Campbell SC, Lane BR. Malignant Renal Tumors. In: Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016. p. 1314–64.
- Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin 2013;63:11–30.
- Cai M, Wei J, Zhang Z, Zhao H, Qiu Y, Fang Y, Gao Z, Cao J, Chen W, Zhou F, Xie D, Luo J. Impact of age on the cancer-specific survival of patients with localized renal cell carcinoma: martingale residual and competing risks analysis. PLoS One 2012; 7:e48489.
- Lane BR, DemirjianS,Derweesh IH, Riedinger CB, Fergany AF, Campbell SC. Is all chronic kidney disease created equal? CurrOpinUrol 2014; 24:127-134.
- Huang WC, Elkin EB, Levey AS, Jang TL, Russo P. Partial nephrectomy versus radical nephrectomy in patients with small renal tumors--is there a difference in mortality and cardiovascular outcomes? J Urol 2009; 181:55-61
- Lin J, Knight EL, Hogan ML, Singh AK. A comparison of prediction equations for estimating glomerular filtration rate in adults without kidney disease. J Am Soc Nephrol. 2003;14:2573–80.
- Lucas SM, Stern JM, Adibi M, Zeltser IS, Cadeddu JA, Raj GV. Renal function outcomes in patients treated for renal masses smaller than 4cm by ablative and extirpative techniques.JUrol 2008;179:75–9
- Barlow LJ, Korets R, Laudano M, Benson M, McKiernan J. Predicting renal functional outcomes after surgery for renal cortical tumours:a multifactorial analysis.BJU Int 2010;106:489–92
- Shirasaki Y, Tsushima T, Saika T, Nasu Y, Kumon H. Kidney function after nephrectomy for renal cell carcinoma. Urology 2004;64(1):43–7, discussion 8.
- Jeon HG, Lee SR, Joo DJ, et al. Predictors of kidney volume change and delayed kidney function recovery after donor nephrectomy. J Urol 2010;184(3):1057–63
- Lesage K, JoniauS,Fransis K, Van Poppel H. Comparison between open partial and radical nephrectomy for renal tumours: perioperative outcome and health-related quality of life. Eur Urol 2007; 51:614-620.
- Touijer K, Jacqmin D, Kavoussi LR, Montorsi F, Patard JJ, Rogers CG, Russo P, Uzzo RG, Van Poppel H. The expanding role of partial nephrectomy: a critical analysis of indications, results, and complications. Eur Urol 2010; 57:214-222.
- JoniauS,VanderEeckt K, Van Poppel H. The indications for partial nephrectomy in the treatment of renal cell carcinoma. Nat Clin PractUrol 2006; 3:198-205.
- Colli J, Sartor O, Grossman L, Lee BR. Underutilization of partial nephrectomy for stage t1 renal cell carcinoma in the United States, trends from 2000 to 2008. A long way to go. Clin Genitourin Cancer 2012;10(4):219–24.
- Van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A,B orkowskiA, Colombel M, Klotz L, Skinner E, Keane T, Marreaud S, Collette S, Sylvester R. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol 2011; 59:543-552.
- Mir MC, Derweesh I, Porpiglia F, Zargar H, Mottrie A, Autorino R. Partial Nephrectomy Versus Radical Nephrectomy for Clinical T1b and T2 Renal Tumors: A Systematic Review and Meta-analysis of Comparative Studies. Eur Urol. 2017;71:606–17.
Corresponding Author
Shanmugha Das K.V
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v6i11.52
