Department of Urology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
Department of Urology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey.
J Laparoendosc Adv Surg Tech A. 2021 Apr;31(4):402-409. doi: 10.1089/lap.2020.1014. Epub 2021 Feb 15.
Our study aims to evaluate the influence of potential determinants of glomerular filtration rate (GFR) decrease after partial nephrectomy (PN), including renal parenchymal loss and other clinical, tumoral, and surgical factors. Eighty-six patients who had undergone PN and for whom preoperative and postoperative computerized tomography scans were available were selected. We calculated the preoperative total kidney volumes, tumor volumes, and postoperative total kidney volumes 1 year after surgery using a three-dimensional (3D) volume segmentation method. Factors that may be potential determinants of percent GFR decrease were also evaluated, including patient age, type of procedure (laparoscopic vs. open), comorbidity index, preoperative GFR, tumor size and volume, RENAL nephrometry score, warm ischemia time, and 3D calculated renal parenchymal loss. Clinical, surgical, and tumor parameters potentially associated with renal parenchymal loss were evaluated. The mean age of the patients was 58 years, the mean tumor diameter was 3.6 cm, and the mean tumor volume was 11.7 cc. The mean percent of renal parenchymal loss was 22.3%, and the mean percent of GFR loss was 17.3%. The renal parenchymal loss was strongly associated with age ( = 0.702, = .02), Charlson comorbidities index ( = 0.768, < .001), and RENAL nephrometry score ( = 0.812, < .001). In multivariate logistic regression analysis, older age, higher Charlson comorbidities index, higher percent renal parenchymal loss, and higher RENAL nephrometry score were independently associated with higher percent of GFR loss. Of all the factors analyzed, RENAL score and Charlson comorbidities index were the most accurate predictors of postoperative parenchymal loss. Also, the percent decrease in GFR at late time points was associated with renal volume preservation and quality of the remnant parenchyma.
我们的研究旨在评估部分肾切除术 (PN) 后肾小球滤过率 (GFR) 下降的潜在决定因素的影响，包括肾实质损失和其他临床、肿瘤和手术因素。选择了 86 名接受过 PN 且术前和术后均有计算机断层扫描的患者。我们使用三维 (3D) 体积分割方法计算了术前总肾体积、肿瘤体积和术后 1 年的总肾体积。还评估了可能是 GFR 下降潜在决定因素的因素，包括患者年龄、手术类型（腹腔镜与开放）、合并症指数、术前 GFR、肿瘤大小和体积、RENAL 肾切除术评分、热缺血时间和 3D 计算的肾实质损失。评估了与肾实质损失相关的临床、手术和肿瘤参数。患者的平均年龄为 58 岁，平均肿瘤直径为 3.6cm，平均肿瘤体积为 11.7cc。平均肾实质损失率为 22.3%，平均 GFR 损失率为 17.3%。肾实质损失与年龄（ = 0.702， = 0.02）、Charlson 合并症指数（ = 0.768， < .001）和 RENAL 肾切除术评分（ = 0.812， < .001）密切相关。多元逻辑回归分析显示，年龄较大、Charlson 合并症指数较高、肾实质损失百分比较高和 RENAL 肾切除术评分较高与较高的 GFR 损失百分比独立相关。在分析的所有因素中，RENAL 评分和 Charlson 合并症指数是术后实质损失的最准确预测因子。此外，晚期 GFR 下降百分比与肾体积保存和残余实质质量有关。
