1 Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center , New York, New York.
J Endourol. 2013 Nov;27(11):1371-5. doi: 10.1089/end.2012.0702. Epub 2013 May 23.
Several factors have been shown to impact the overall glomerular filtration (GFR) rate after partial nephrectomy. Change in overall GFR, however, does not necessarily reflect the impact of these factors on the operated kidney. Using preoperative and postoperative renal scintigraphy, we sought to assess the impact of patient, tumor, and operative factors on GFR of the affected kidney (proportional GFR).
We identified 73 patients who underwent minimally invasive partial nephrectomy with preoperative and postoperative renal scans from two institutions. Patient, tumor, and operative characteristics were recorded. We used multiple linear regression to determine the patient and clinical factors predictive of postoperative proportional GFR in the operated kidney. We tested for an interaction between preoperative proportional GFR and nephrometry score and ischemia. We further fitted two separate linear models to compare the proportion of variance (R(2)) explained by ischemia time in change in renal function in the operated kidney with the change in renal function in both kidneys.
Surgical parameters (procedure approach, ischemia time, and estimated blood loss) and preoperative proportional GFR were significantly associated with postoperative proportional GFR. Preoperative proportional GFR (β=5.93, 95% confidence interval [CI]: 3.88, 7.97, P<0.0005) and procedure approach (β=8.67, 95% CI: 4.50, 12.80, P<0.0005) were strongly associated with outcome while ischemia time (β=-1.80, 95% CI: -3.48, -0.11, P=0.04) and estimated blood loss (β=-1.15, 95% CI: -0.29, -0.01, P=0.04) just reached statistical significance. The interaction term between preoperative proportional GFR and nephrometry score or ischemia time was not statistically significant (nephrometry, P=0.2 continuous or P=0.6 categorical, and ischemia, P=0.7, respectively).
Lower preoperative proportional GFR, longer ischemia times, and higher blood loss all negatively impact postoperative proportional GFR while tumor complexity as gauged by morphometry scoring does not. Larger studies are needed to determine whether renal scintigraphy is a more accurate method of measuring the impact of the ischemia time on postoperative proportional GFR.
多项因素已被证实会影响部分肾切除术后的整体肾小球滤过率（GFR）。然而，整体 GFR 的变化并不一定反映这些因素对手术肾脏的影响。我们使用术前和术后肾闪烁扫描来评估患者、肿瘤和手术因素对患侧肾脏（比例 GFR）GFR 的影响。
我们从两个机构中确定了 73 名接受微创部分肾切除术且有术前和术后肾扫描的患者。记录患者、肿瘤和手术特征。我们使用多元线性回归来确定预测手术侧肾脏术后比例 GFR 的患者和临床因素。我们检测了术前比例 GFR 与肾肿瘤评分和缺血之间的相互作用。我们进一步拟合了两个单独的线性模型，以比较手术侧肾脏功能变化中的缺血时间解释的变异比例（R²）与双侧肾脏功能变化中的变异比例。
手术参数（手术途径、缺血时间和估计失血量）和术前比例 GFR 与术后比例 GFR 显著相关。术前比例 GFR（β=5.93，95%置信区间 [CI]：3.88，7.97，P<0.0005）和手术途径（β=8.67，95% CI：4.50，12.80，P<0.0005）与结局密切相关，而缺血时间（β=-1.80，95% CI：-3.48，-0.11，P=0.04）和估计失血量（β=-1.15，95% CI：-0.29，-0.01，P=0.04）仅达到统计学意义。术前比例 GFR 与肾肿瘤评分或缺血时间的交互项无统计学意义（肾肿瘤评分，P=0.2 连续或 P=0.6 分类，和缺血，P=0.7）。
较低的术前比例 GFR、较长的缺血时间和较高的失血量均对术后比例 GFR 产生负面影响，而形态计量评分评估的肿瘤复杂性则没有。需要更大的研究来确定肾闪烁扫描是否是一种更准确的方法来测量缺血时间对术后比例 GFR 的影响。
