1 Section of Urology, University of Chicago , Chicago, Illinois.
J Endourol. 2014 Feb;28(2):196-200. doi: 10.1089/end.2013.0486. Epub 2013 Nov 4.
To identify predictors of nonneoplastic parenchymal volume excised during minimally invasive partial nephrectomy (PN) and determine the impact on postoperative renal function.
A total of 206 patients underwent laparoscopic or robot-assisted PN between 2003 and 2011. Parenchymal volume was estimated by subtraction of calculated tumor volume from total specimen volume. Univariate and multivariate regression analyses were used to examine the association of parenchymal volume with tumor and surgical factors. Percent and absolute changes in estimated glomerular filtration rate (eGFR) on the day after surgery, 1 to 12 months, and >12 months after surgery were correlated with parenchymal volume.
Increased tumor size (P<0.001), earlier era of surgery (P=0.04), and longer ischemia time (P=0.05) were associated with higher parenchymal volume. Robotic surgery was not associated with better parenchymal preservation. Median percent change in eGFR at 1 to 12 months (mean=6.7 months) and >12 months (mean=28.3 months) was -10.9% and -12.1%, respectively. No association was found between the volume of parenchyma and change in eGFR. Longer ischemia time was associated with decrease in eGFR only the first day after surgery (P=0.005). Higher body mass index BMI and Charlson comorbidity index and lower preoperative eGFR were associated with decrease in eGFR 1 to 12 months after surgery (P=0.006, 0.04, 0.001, respectively).
In our cohort, larger tumors, longer ischemia time, and earlier era of PN were associated with increased amount of nonneoplastic parenchyma excised during surgery. We did not observe a relationship between absolute volume of parenchyma and change in renal function after surgery. Baseline renal function and comorbidities were the strongest determinants of long-term renal function.
确定微创部分肾切除术（PN）中切除的非肿瘤实质体积的预测因子，并确定其对术后肾功能的影响。
2003 年至 2011 年间，共有 206 例患者接受了腹腔镜或机器人辅助 PN。通过从总标本体积中减去计算出的肿瘤体积来估计实质体积。使用单变量和多变量回归分析来检查实质体积与肿瘤和手术因素的关联。术后第一天、1 至 12 个月和>12 个月时估计肾小球滤过率（eGFR）的百分比和绝对变化与实质体积相关。
肿瘤大小增加（P<0.001）、手术早期（P=0.04）和较长的缺血时间（P=0.05）与更高的实质体积相关。机器人手术与更好的实质保存无关。术后 1 至 12 个月（平均=6.7 个月）和>12 个月（平均=28.3 个月）的 eGFR 百分比变化中位数分别为-10.9%和-12.1%。实质体积与 eGFR 变化之间未发现关联。较长的缺血时间仅与术后第一天的 eGFR 下降有关（P=0.005）。较高的体重指数（BMI）和 Charlson 合并症指数以及较低的术前 eGFR 与术后 1 至 12 个月的 eGFR 下降相关（P=0.006、0.04、0.001）。
在我们的队列中，较大的肿瘤、较长的缺血时间和较早的 PN 时期与手术中切除的非肿瘤实质量增加有关。我们没有观察到术后肾功能变化与实质体积绝对值之间的关系。基线肾功能和合并症是长期肾功能的最强决定因素。
