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Hamilton ZA , Uzzo RG , Larcher A , Lane BR , Ristau B , Capitanio U , Ryan S , Dey S , Correa A , Reddy M , Proudfoot JA , Nasseri R , Yim K , Noyes S , Bindayi A , Montorsi F , Derweesh IH
Comparison of functional outcomes of robotic and open partial nephrectomy in patients with pre-existing chronic kidney disease: a multicenter study
World J Urol. 2018 Aug;36(8) :1255-1262
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Abstract
BACKGROUND: We compared renal functional outcomes of robotic (RPN) and open partial nephrectomy (OPN) in patients with chronic kidney disease (CKD), a definite indication for nephron-sparing surgery. METHODS: A multicenter retrospective analysis of OPN and RPN in patients with baseline >/= CKD Stage III [estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m(2)] was performed. Primary outcome was change in eGFR (DeltaeGFR, mL/min/1.73 m(2)) between preoperative and last follow-up with respect to RENAL nephrometry score group [simple (4-6), intermediate (7-9), complex (10-12)]. Secondary outcomes included eGFR decline > 50%. RESULTS: 728 patients (426 OPN, 302 RPN, mean follow-up 33.3 months) were analyzed. Similar RENAL score distribution (p = 0.148) was noted between groups. RPN had lower median estimated blood loss (p < 0.001), and hospital stay (3 vs. 5 days, p < 0.001). Median ischemia time (OPN 23.7 vs. RPN 21.5 min, p = 0.089), positive margin (p = 0.256), transfusion (p = 0.166), and 30-day complications (p = 0.208) were similar. For OPN vs. RPN, mean DeltaeGFR demonstrated no significant difference for simple (0.5 vs. 0.3, p = 0.328), intermediate (2.1 vs. 2.1, p = 0.384), and complex (4.9 vs. 6.1, p = 0.108). Cox regression analysis demonstrated that decreasing preoperative eGFR (OR 1.10, p = 0.001) and complex RENAL score (OR 5.61, p = 0.03) were independent predictors for eGFR decline > 50%. Kaplan-Meier analysis demonstrated 5-year freedom from eGFR decline > 50% of 88.6% for OPN and 88.3% for RPN (p = 0.724). CONCLUSIONS: RPN and OPN demonstrated similar renal functional outcomes when stratified by tumor complexity group. Increasing tumor age and tumor complexity were primary drivers associated with functional decline. RPN provides similar renal functional outcomes to OPN in appropriately selected patients.
Notes
1433-8726 Hamilton, Zachary A Uzzo, Robert G Larcher, Alessandro Lane, Brian R Ristau, Benjamin Capitanio, Umberto Ryan, Stephen Dey, Sumi Correa, Andres Reddy, Madhumitha Proudfoot, James A Nasseri, Ryan Yim, Kendrick Noyes, Sabrina Bindayi, Ahmet Montorsi, Francesco Derweesh, Ithaar H UL1TR000100/National Institutes of Health UL1TR001442/National Institutes of Health Journal Article Germany World J Urol. 2018 Mar 12. pii: 10.1007/s00345-018-2261-3. doi: 10.1007/s00345-018-2261-3.