Changes in Renal Function After Laparoscopic Partial Nephrectomy: Comparison With Laparoscopic Radical Nephrectomy

Abstract

PurposeTo evaluate alterations in renal function after laparoscopic radical nephrectomy (LRN) and laparoscopic partial nephrectomy (LPN) for renal tumors.Materials and MethodsFrom March 2008 to August 2011, we performed 175 cases of laparoscopic kidney resection. Among these, we excluded patients who received perioperative immunotherapy or target therapy and also patients with a preoperative estimated glomerular filtration rate (eGFR) <60 mL/min. A total of 32 patients undergoing LPN and 92 patients undergoing LRN were enrolled. We retrospectively reviewed the changes in eGFR (by the modification of diet in renal disease method) at the following time points: preoperative, postoperative 1 week, and postoperative 1, 3, 6, and 12 months.ResultsThe mean warm ischemia time of the LPN group was 22 minutes (range, 0 to 47 minutes). Mean eGFR values (mL/min/1.73 m2) during postoperative week 1 and 1, 3, 6, and 12 months were 70.8, 71.5, 76.7, 76.0, and 75.3 in the LPN group and 52.1, 50.6, 52.8, 53.4, and 52.4 in the LRN group, respectively. One year after the operation, 6.3% (2 patients) of LPN patients and 68.5% (63 patients) of LRN patients had progressed to chronic renal insufficiency (eGFR<60 mL/min/1.73 m2).ConclusionsRenal function recovered slightly after LPN and LRN and was maintained constantly after 3 months. However, renal function showed different patterns of decrease. Despite the concern for warm ischemia, LPN can preserve renal function better than can LRN. LPN should be considered for selected patients to prevent chronic renal insufficiency.

Estimated glomerular filtration rate's time to nadir after robot‐assisted partial nephrectomy: Predictors and clinical significance on renal functional recovery

“…reported that one‐third of patients with preoperative CKD I or II will progress to CKD stage III after PN . In light of this, many studies have focused on differences in preoperative eGFR and their subsequent risk for the development of new‐onset CKD after PN . These cumulative efforts put the value of weighing the risks of PN and adverse sequela related to renal insufficiency with risk of cancer progression.…”

The incidence and risk factors of chronic kidney disease after radical nephrectomy in patients with renal cell carcinoma

“…Previous studies showed that, age, race, sex, diabetes, hypertension, smoking, obesity, proteinuria and some clinical factors were risk factors for chronic kidney disease [ 11 – 14 ]. In our study, there were significant differences between the CKD group and the no-CKD group in age, sex, preoperative GFR value, preoperative contralateral GFR value, β2-microglobulin, tumor size and Immediate postoperative eGFR value.…”

Current Status of Laparoscopic Partial Nephrectomy

“…1,2 The oncological outcome of partial nephrectomy (PN) is comparable to that of radical nephrectomy (RN), and some reports that the overall survival (OS) is better after a PN than after a RN. .…”