Department of Urology, Columbia University Medical Center, New York, NY, USA.
BJU Int. 2010 Aug;106(4):489-92. doi: 10.1111/j.1464-410X.2009.09147.x. Epub 2009 Dec 18.
To examine the functional outcomes after radical (RN) and partial nephrectomy (PN) stratified by variables before and after surgery, using estimated glomerular filtration rate (eGFR), as nephrectomy is the standard treatment for localized renal tumours, but the risk of developing chronic kidney disease (CKD) increases after surgery.
We retrospectively analysed patients treated with PN or RN for renal cancer at one institution from 1988 to 2008. Chronic renal function before and after surgery was measured using the eGFR computed using the Modification of Diet in Renal Disease equation. Four outcomes were measured: (i) presence of new-onset renal insufficiency (eGFR <60 mL/min/1.73m(2)); (ii) the percentage change in eGFR; (iii) the change in CKD stage; and (iv) the presence of CKD upstaging. Regression models were used to determine the effect of surgical procedure (RN vs PN), access technique (open vs laparoscopic) and several preoperative characteristics on functional outcomes.
In all, 276 patients met the inclusion criteria (174 RN and 102 PN) of whom 209 had a preoperative eGFR of >60 mL/min/1.73m(2). After >or=3 months from surgery, 108/209 (52%) patients developed new-onset eGFR of <60 mL/min/1.73m(2). On multivariate analysis, preoperative CKD stage (P < 0.001) and procedure (P= 0.001) were both independent predictors of all four functional outcomes measured. Also, hypertension was an independent predictor of CKD upstaging (P= 0.02). Surgical access technique was not an independent predictor of any of the renal functional outcomes measured.
Patients undergoing renal surgery have a high rate of new-onset CKD afterward. After controlling for preoperative risk factors, patients undergoing RN are at greater risk of a decline in renal function. However, surgical access technique was not a significant predictor for renal impairment.
通过术前和术后的变量，检查根治性肾切除术（RN）和部分肾切除术（PN）的功能结果，使用估算肾小球滤过率（eGFR）。因为肾切除术是治疗局限性肾肿瘤的标准治疗方法，但手术后发生慢性肾脏病（CKD）的风险会增加。
我们回顾性分析了 1988 年至 2008 年期间在一家机构接受 PN 或 RN 治疗的肾癌患者。使用基于肾脏病饮食改良公式计算的 eGFR 测量手术前后的慢性肾功能。测量了四种结果：（i）新发生的肾功能不全（eGFR <60 mL/min/1.73m2）；（ii）eGFR 的变化百分比；（iii）CKD 分期的变化；和（iv）CKD 升级的存在。回归模型用于确定手术程序（RN 与 PN）、入路技术（开放与腹腔镜）和术前几个特征对功能结果的影响。
总共 276 名患者符合纳入标准（174 名 RN 和 102 名 PN），其中 209 名患者术前 eGFR >60 mL/min/1.73m2。术后 >或=3 个月，209 名患者中有 108 名（52%）新发生 eGFR <60 mL/min/1.73m2。多变量分析显示，术前 CKD 分期（P < 0.001）和手术程序（P = 0.001）都是所有四种功能结果的独立预测因素。此外，高血压是 CKD 升级的独立预测因素（P = 0.02）。手术入路技术不是所测量的任何肾功能结果的独立预测因素。
接受肾手术的患者术后发生新发 CKD 的比率很高。在控制术前危险因素后，接受 RN 的患者肾功能下降的风险更大。然而，手术入路技术不是肾功能损害的重要预测因素。
