Glickman Urological & Kidney Institute, Department of Urology, Cleveland Clinic, Cleveland, OH, USA.
Glickman Urological & Kidney Institute, Department of Urology, Cleveland Clinic, Cleveland, OH, USA.
Eur Urol. 2017 Aug;72(2):168-170. doi: 10.1016/j.eururo.2017.02.004. Epub 2017 Mar 1.
Renal function after partial nephrectomy (PN) may depend on modifiable factors including ischemia time, excision of healthy parenchyma (excisional volume loss, EVL), and reconstructive methods. We retrospectively reviewed our institutional robotic PN database to identify the predictors of glomerular filtration rate (GFR) preservation (GFR-P) at 3-12 mo postoperatively, during which GFR decline plateaus. Baseline clinical, sociodemographic, and radiologic characteristics were captured. Univariate and multivariate (MV) linear regression analyses were performed and marginal effects were employed to examine the relative effect of EVL on renal function. A total of 647 patients who underwent robotic PN had GFR data at a median follow-up of 6 mo. On MV models, EVL was significantly correlated with GFR-P following log transformation (p=0.001). Each doubling of EVL caused a 1.5% decrease in GFR-P. Ischemia time and tumor complexity were not significantly associated with GFR-P. In summary, GFR-P after PN appears to be significantly associated with the excised volume of benign parenchyma.
At a high-volume tertiary care center, we investigated the impact of surgical factors on kidney function after kidney cancer surgery. We found that the surgical precision with which the tumor is excised significantly impacts kidney function at 3-12 mo after surgery.
部分肾切除术（PN）后的肾功能可能取决于可改变的因素，包括缺血时间、健康肾实质的切除（切除体积损失，EVL）和重建方法。我们回顾性地审查了我们机构的机器人 PN 数据库，以确定术后 3-12 个月肾小球滤过率（GFR）保存（GFR-P）的预测因素，在此期间 GFR 下降趋于平稳。收集了基线临床、社会人口统计学和影像学特征。进行了单变量和多变量（MV）线性回归分析，并采用边缘效应来检查 EVL 对肾功能的相对影响。共有 647 例接受机器人 PN 的患者在中位随访 6 个月时具有 GFR 数据。在 MV 模型中，EVL 与对数转换后的 GFR-P 显著相关（p=0.001）。EVL 每增加一倍，GFR-P 就会下降 1.5%。缺血时间和肿瘤复杂性与 GFR-P 无显著相关性。总之，PN 后 GFR-P 似乎与良性实质切除的体积显著相关。
在一家高容量的三级护理中心，我们研究了手术因素对肾癌手术后肾功能的影响。我们发现，肿瘤切除的手术精度显著影响术后 3-12 个月的肾功能。
