Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
J Urol. 2024 Sep;212(3):431-440. doi: 10.1097/JU.0000000000004099. Epub 2024 Jun 12.
Reoperative partial nephrectomy (RePN) offers several advantages for the treatment of recurrent, multifocal renal masses. RePN has been previously demonstrated to be technically feasible and delay the need for renal replacement therapy. However, there is still inherent complexity and known risks to reoperative nephrectomy. We studied the largest population of RePNs to characterize renal functional outcomes and the likelihood of intra- and postoperative complications.
Query of an institutional surgical registry was conducted. Demographic data, serum creatinine for estimated glomerular filtration rate (eGFR), and protein dipstick results were assessed within 1 week prior to surgery, and postoperative function assessments were studied within a year of surgery. RePN was defined as serial surgical resection of the ipsilateral renal unit.
A total of 1131 partial nephrectomies performed on 663 patients at a single center were retrospectively evaluated. In reoperative cases, median number of operations per renal unit was 2 (range: 2-6). There was a stepwise decline in eGFR with an average decline of 6.1 with each RePN. With each subsequent nephrectomy, surgical duration, estimated blood loss, and incidence of preoperative anemia increased. Postoperative eGFR showed a significant positive association with preoperative eGFR, while negative associations were found with age, number of previous ipsilateral partial nephrectomies, number of tumors, and largest tumor size. High-grade complications were associated with the number of ipsilateral partial nephrectomies, tumor count, and tumor size. Robotic or laparoscopic procedures exhibited a likelihood of grade 3 or greater complications compared to open surgery.
RePN contributes to renal dysfunction and an increased risk of surgical complications. Intraoperative blood loss and surgical duration increase with subsequent nephrectomy. Such risks are dependent on the number of prior operative interventions on the kidney, suggesting a stepwise progression of surgical morbidity.
对于复发性、多灶性肾肿瘤的治疗，再次部分肾切除术（RePN）具有多项优势。此前已经证明，RePN 在技术上是可行的，可以延迟进行肾脏替代治疗的时间。然而，再次进行肾切除术仍然存在固有复杂性和已知风险。我们研究了最大的 RePN 人群，以描述肾功能结果和发生围手术期并发症的可能性。
对机构手术登记处进行了查询。在手术前 1 周内评估了人口统计学数据、血清肌酐估算肾小球滤过率（eGFR）和蛋白试纸结果，术后一年内对肾功能进行了评估。将 RePN 定义为同侧肾脏单位的连续手术切除。
在单个中心对 663 名患者进行了 1131 次部分肾切除术，回顾性评估了这些患者的数据。在再次手术的病例中，每个肾脏单位的平均手术次数为 2 次（范围：2-6 次）。eGFR 呈逐步下降趋势，每次 RePN 平均下降 6.1。随着每次后续肾切除术，手术时间、估计失血量和术前贫血发生率增加。术后 eGFR 与术前 eGFR 呈显著正相关，而与年龄、同侧部分肾切除术次数、肿瘤数量和最大肿瘤大小呈负相关。高等级并发症与同侧部分肾切除术次数、肿瘤计数和肿瘤大小相关。与开放手术相比，机器人或腹腔镜手术发生 3 级或更高级别并发症的可能性更高。
RePN 导致肾功能障碍和手术并发症风险增加。随着后续肾切除术的进行，术中失血量和手术时间增加。这些风险取决于肾脏的先前手术干预次数，表明手术发病率呈逐步进展。
