Hypertension and Cardiovascular Morbidity Following Surgery for Kidney Cancer

Abstract

Background: Despite better renal function following nephron-sparing surgery (NSS) relative to radical nephrectomy (RN), there is no consensus with respect to the long-term sequelae associated with surgery. Objective: To investigate the effect of surgery and the temporal pattern of two different cardiovascular event (CVe) categories after NSS versus RN. Design, setting, and participants: We collected data of 898 patients with cT1-2 N0 M0 renal mass and no history of CVe treated with NSS versus RN. CVe categories were dichotomised in (1) de novo hypertension (HT) and (2) other major cardiovascular events (MCEs). Outcome measurements and statistical analysis: Multivariable competing regression analyses (MVAs) tested the adjusted effect of surgery type on each CVe category. Results and limitations: Among patients treated with RN, 38% of HT events occurred immediately after surgery. Conversely, in NSS counterparts, the onset of HT was diluted over the years after surgery (10% of HT events in the first 6 mo). When an MCE was considered, an increasing long-term time-dependent prevalence of the outcome was observed in both groups, with no statistically significantly difference between NSS and RN. At MVA, RN was associated with a higher HT risk (hazard ratio [HR] 2.89; p = 0.006) than but a similar MCE risk (HR 0.85; p = 0.6) to NSS. Conclusions: Relative to RN, NSS showed an independent protective effect on HT but not on MCEs. In patients with no history of preoperative HT or MCEs, the onset of HT after RN is a very early event, due probably to the acute loss of renal parenchyma. This is not the case for the other cardiovascular morbidity, which develops in the long-term period, regardless of the type of surgery performed.

Robotic partial nephrectomy versus radical nephrectomy in elderly patients with large renal masses

“…in addition, recent evidence that NSS might provide better cancer specific mortality may warrant consideration for large renal masses even in an elective setting. 6,16 contrary to previous reports, we found no statistically significant difference regarding clinical tumor size; however, rrN was mostly performed for complex tumors. given the median age of our cohort, one might argue that this could be consequence of the patients age, who are usually managed with rN than PN due to concerns of surgical complications.…”

“…3 The widespread adoption of robotic surgery and its well-known technical advantages in terms of visualization and handling of the anatomical structures favored the use of robot-assisted PN (rPN) for large renal masses as well. 4,5 in addition, cardiovascular, 6 and oncological outcomes 7 indicate that PN could also be suitable for elderly patients, who are usually more likely to be elected to rN. 8,9 furthermore, recent evidence suggests that the "oldest old" patients might benefit of PN in terms of surgical functional outcomes, and oncological safety.…”

Toward Individualized Approaches to Partial Nephrectomy: Assessing the Correlation Between Ischemia Time and Patient Health Status (RECORD2 Project)

“…It is noteworthy that we did not include comorbidities in our preoperative model. Although prior investigators observed an association between AKI and diabetes [18], hypertension [10,19], or smoking status [10], there are reasons to believe that this relationship might be more apparent than real. First, other papers failed to confirm these findings [10,20,21], suggesting that the established association between medical conditions and renal function [5] might not hold true when taking into account a one-time event such as surgical AKI.…”

Competing Risk Analysis of Cardiovascular/Cerebrovascular Death in T1/2 Kidney Cancer: A SEER Database Analysis

“…Huang et al analyzed the SEER-Medicare, and made a conclusion that nearly 20% cardiovascular events rate increased after KC patients treating with radical nephrectomy than nephron-sparing surgery 21 . Umberto et al reported that nephron-sparing surgery showed an independent protective effect on hypertension in KC patients without preoperative cardiovascular disease, but not on other major cardiovascular events 22 . One of the possible pathophysiological mechanisms of this nding is the acute loss of half of nephrons may induce a compensatory function of remaining kidney that increases the arterial blood in ow by activation of the renin-angiotensin-aldosterone system 23,24 .…”