Recovery of renal function after open and laparoscopic partial nephrectomy Journal Article

Authors: Adamy, A.; Favaretto, R. L.; Nogueira, L.; Savage, C.; Russo, P.; Coleman, J.; Guillonneau, B.; Touijer, K.
Article Title: Recovery of renal function after open and laparoscopic partial nephrectomy
Abstract: Background: Although oncologic outcomes appear to be similar after laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN), data on renal function are lacking. Objective: To evaluate the change over time in renal function after LPN and OPN. Design, setting, and participants: We identified 987 patients with a single sporadic tumor and a normal contralateral kidney who were treated by LPN (n = 182) and OPN (n = 805) between January 2002 and July 2009. Intervention: All patients underwent LPN or OPN at Memorial Sloan-Kettering Cancer Center. Measurements: Estimated glomerular filtration rate (GFR) was calculated using the abbreviated Modification of Diet in Renal Disease formula. We created a multivariable generalized estimating equations linear model that predicted GFR based on the time from surgery, preoperative GFR, tumor size, American Society of Anesthesiologists score, and ischemia time. Results and limitations: Mean patient age, tumor size, and ASA score were similar between LPN and OPN patients. The baseline preoperative GFR was lower in the laparoscopic group (67 ml/min per 1.73 m2 vs 73 ml/min per 1.73 m2; p < 0.001). The mean ischemia time was shorter after LPN than OPN (35 min vs 40 min, respectively; p < 0.001). In a multivariable model, the interaction term between time from surgery and approach was statistically significant (p = 0.045), indicating that there was a differential effect on recovery of renal function over time by approach. Laparoscopically treated patients maintained a slightly higher renal function than those treated via an open approach. The 2-mo and 6-mo predicted GFR for a typical patient increased slightly from 65 ml/min per 1.73 m2 to 67 ml/min per 1.73 m 2, respectively, for those treated laparoscopically but remained constant at 62 ml/min per 1.73 m2 after OPN. Conclusions: Our data suggest that the surgical approach has a small effect on the recovery of renal function after partial nephrectomy. Laparoscopically treated patients maintained slightly higher renal function. © 2010 European Association of Urology.
Keywords: adult; middle aged; cancer surgery; surgical technique; recovery of function; major clinical study; laparoscopy; prospective studies; tumor volume; surgical approach; kidney neoplasms; nephrectomy; time factors; cancer center; partial nephrectomy; kidney tumor; ischemia; kidney function; operation duration; intermethod comparison; glomerular filtration rate; glomerulus filtration rate; multivariate analysis; laparoscopic partial nephrectomy; open partial nephrectomy; single sporadic tumor
Journal Title: European Urology
Volume: 58
Issue: 4
ISSN: 0302-2838
Publisher: Elsevier Science, Inc.  
Date Published: 2010-10-01
Start Page: 596
End Page: 601
Language: English
DOI: 10.1016/j.eururo.2010.05.044
PUBMED: 20554375
PROVIDER: scopus
Notes: --- - "Export Date: 20 April 2011" - "CODEN: EUURA" - "Source: Scopus"
Citation Impact
MSK Authors
  1. Jonathan Coleman
    233 Coleman
  2. Caroline Savage
    80 Savage
  3. Paul Russo
    505 Russo
  4. Abdelkrim Karim Touijer
    213 Touijer