Zargar Homayoun, Akca Oktay, Autorino Riccardo, Brandao Luis Felipe, Laydner Humberto, Krishnan Jayram, Samarasekera Dinesh, Stein Robert J, Kaouk Jihad H
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
BJU Int. 2015 May;115(5):787-95. doi: 10.1111/bju.12825. Epub 2014 Dec 7.
To objectively assess ipsilateral renal function (IRF) preservation and factors influencing it after robot-assisted partial nephrectomy (RAPN).
Our database was queried to identify patients who had undergone RAPN from 2007 to 2013 and had complete pre- and postoperative mercapto-acetyltriglycine (MAG3) renal scan assessment. The estimated glomerular filtration rate (eGFR) for the operated kidney was calculated by multiplying the percentage of contribution from the renal scan by the total eGFR. IRF preservation was defined as a ratio of the postoperative eGFR for the operated kidney to the preoperative eGFR for the operated kidney. The percentage of total eGFR preservation was calculated in the same manner (postoperative eGFR/preoperative eGFR × 100). The amount of healthy rim of renal parenchyma removed was assessed by deducting the volume of tumour from the volume of the PN specimen assessed on pathology. Multivariable linear regression was used for analysis.
In all, 99 patients were included in the analysis. The overall median (interquartile range) total eGFR preservation and IRF preservation for the operated kidney was 83.83 (75.2-94.1)% and 72 (60.3-81)%, respectively (P < 0.01). On multivariable analysis, volume of healthy rim of renal parenchyma removed, warm ischaemia time (WIT) > 30 min, body mass index (BMI) and operated kidney preoperative eGFR were predictive of IRF preservation.
Using total eGFR tends to overestimate the degree of renal function preservation after RAPN. This is particularly relevant when studying factors affecting functional outcomes after nephron-sparing surgery. IRF may be a more precise assessment method in this setting. Operated kidney baseline renal function, BMI, WIT >30 min, and amount of resected healthy renal parenchyma represent the factors with a significant impact on the IRF preservation. RAPN provides significant preservation of renal function as shown by objective assessment criteria.
客观评估机器人辅助部分肾切除术（RAPN）后同侧肾功能（IRF）的保留情况及其影响因素。
查询我们的数据库，以确定2007年至2013年期间接受RAPN且术前和术后均有完整的巯基乙酰三甘氨酸（MAG3）肾扫描评估的患者。通过将肾扫描贡献百分比乘以总估算肾小球滤过率（eGFR）来计算手术侧肾脏的eGFR。IRF保留定义为手术侧肾脏术后eGFR与术前eGFR的比值。以相同方式计算总eGFR保留百分比（术后eGFR/术前eGFR×100）。通过从病理评估的肾部分切除术（PN）标本体积中减去肿瘤体积来评估切除的健康肾实质边缘量。采用多变量线性回归进行分析。
总共99例患者纳入分析。手术侧肾脏的总体eGFR保留中位数（四分位间距）和IRF保留中位数分别为83.83（75.2 - 94.1）%和72（60.3 - 81）%（P < 0.01）。多变量分析显示，切除的健康肾实质边缘量、热缺血时间（WIT）> 30分钟、体重指数（BMI）以及手术侧肾脏术前eGFR是IRF保留的预测因素。
使用总eGFR往往会高估RAPN后肾功能的保留程度。在研究保留肾单位手术后影响功能结局的因素时，这一点尤为重要。在此情况下，IRF可能是一种更精确的评估方法。手术侧肾脏的基线肾功能、BMI、WIT > 30分钟以及切除的健康肾实质量是对IRF保留有显著影响的因素。如客观评估标准所示，RAPN能显著保留肾功能。
