Robotic Partial Nephrectomy for Small Renal Masses in Patients With Pre-existing Chronic Kidney Disease - 26/09/12
Reprint requests: Georges-Pascal Haber, M.D., Cleveland Clinic, Glickman Urological and Kidney Institute, GUKI, Q-10, 9500 Euclid Avenue, Cleveland, OH 44195Résumé |
Objective |
To assess the outcomes of robotic partial nephrectomy in patients with pre-existing chronic kidney disease (CKD).
Materials and Methods |
Patients who underwent robotic partial nephrectomy for renal tumors between 2007 and 2011 were identified from our prospectively maintained institutional database. Perioperative as well as short-term oncological and functional outcomes were assessed. A comparative analysis was performed between patients with pre-existing CKD (estimated glomerular filtration rate [eGFR] 15-60 mL/min, group 1, n = 52) and patients with eGFR >60 mL/min (group 2, n = 303).
Results |
Group 1 patients were older (median 68 vs 57 years, P < .001), with higher American Society of Anesthesiology (ASA) score (3 vs 2, P < .001) and a higher Charlson comorbidity index (7 vs 4, P < .001). Warm ischemia time (WIT) was similar in both groups (18 vs 18 minutes, P = .52). Group 1 had a higher postoperative complication rate (40.4% vs 21.1%, P = .003). Pathologic and oncological data were similar. After a median follow-up of 3 months (interquartile: 1-10), deterioration of eGFR was lower in group 1 patients (−5% vs −12%, P = .004). No endstage renal disease was noted in either group. There was significantly less CKD upstaging in group 1 than in group 2 (11.5% vs 33.9%, P = .001). After multivariate analysis, preoperative eGFR and WIT were independent predictors of latest eGFR. Less than 15% of patients with normal baseline renal function developed CKD stage III or higher.
Conclusion |
Despite a high risk of surgical complications, robotic partial nephrectomy only marginally affects renal function in patients with pre-existing CKD.
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| Financial Disclosure: Dr. Georges-Pascal Haber has served as a consultant for Intuitive Surgical. Dr. Jihad H. Kaouk has served as a consultant for Intuitive Surgical, Ethicon, and Covidien. The remaining authors declare that they have no relevant financial interests. |
Vol 80 - N° 4
P. 845-851 - octobre 2012 Retour au numéro
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