Functional and oncologic outcomes after nephron-sparing surgery in a solitary kidney: 10 years of experience
AUTOR(ES)
Costabel, José Ignacio, Marchiñena, Patricio García, Tirapegui, Federico, Dantur, Augusto, Jurado, Alberto, Gueglio, Guillermo
FONTE
Int. braz j urol.
DATA DE PUBLICAÇÃO
2016-04
RESUMO
ABSTRACT Objectives: To evaluate functional and oncologic outcomes of partial nephrectomy (PN) in patients with a solitary kidney. Materials and Methods: A retrospective analysis of patients with a solitary kidney undergoing nephron-sparing surgery between March 2003 and March 2013 was performed. GFR was recorded before the procedure and 3 months after surgery, thus establishing a change (cGFR). Several variables that may influence cGFR were analyzed. Complications are herein described, namely bleeding, fistula, acute renal failure and end-stage renal disease (ESRD). Local recurrence and margin status are also described. Survival rates were calculated using the Kaplan Meier method (2 patients with metastasis at the time of surgery were excluded from the analysis). Results: Forty-five patients were available for analysis. Median follow-up was 27.56 months (r 3-96). Mean cGFR was-7.12mL/min (SD 2.1). Variables significantly related with lower GFR after surgery were loss of renal mass (p=0.01)) and male gender (p=0.03). Four patients (8.8%) experienced hemorrhage. Nine patients (20%) developed a urinary fistula. Only one patient with bleeding required open surgery. Two patients (4.4%) needed transient dialysis. Three patients (6.6%) developed ESRD. Four patients (8.8%) had positive surgical margins (PSMs) and four patients (88%) had local recurrence (2 of these had PSMs). Five patients (11.1%) died during follow-up. Four patients (8.8%) died because of renal cancer. Estimated 2-year overall survival, disease-free survival and cancer specific survival rates were 88.4% (CI 95% 70.5-96); 87.7% (CI 95% 68.1-96) and 92.4% (CI 95% 75-98), respectively. Conclusion: Loss of renal mass and male gender were associated with lower postoperative GFR. Our outcomes were comparable with those in the World literature.
Documentos Relacionados
- Solitary kidney and thirteen (13) tumors: Laparoscopic radical nephroureterectomy, bench ex-vivo nephron-sparing surgery and auto-transplantation
- Clampless laparoscopic partial nephrectomy: a step towards a harmless nephron-sparing surgery?
- Nephron-sparing surgery for treatment of reninoma: a rare renin secreting tumor causing secondary hypertension
- The potential threats and benefits of nephron-sparing surgery can be predicted by any available score system
- Nephrometry scoring systems: their importance for the planning of nephron-sparing surgery and the relationships among them