PD16-09 MINIMIZING NORMAL PARENCHYMAL LOSS DURING PARTIAL NEPHRECTOMY PRESERVES LONG-TERM RENAL FUNCTION WITHOUT IMPACTING LOCAL RECURRENCE

Abstract

You have accessJournal of UrologyKidney Cancer: Localized I1 Apr 2014PD16-09 MINIMIZING NORMAL PARENCHYMAL LOSS DURING PARTIAL NEPHRECTOMY PRESERVES LONG-TERM RENAL FUNCTION WITHOUT IMPACTING LOCAL RECURRENCE Srinath Kotamarti, Michael B. Rothberg, Matthew Danzig, Shumaila Saad, Jared Levinson, Mitchell C. Benson, James M. McKiernan, and Ketan K. Badani Srinath KotamartiSrinath Kotamarti More articles by this author , Michael B. RothbergMichael B. Rothberg More articles by this author , Matthew DanzigMatthew Danzig More articles by this author , Shumaila SaadShumaila Saad More articles by this author , Jared LevinsonJared Levinson More articles by this author , Mitchell C. BensonMitchell C. Benson More articles by this author , James M. McKiernanJames M. McKiernan More articles by this author , and Ketan K. BadaniKetan K. Badani More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1154AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Nephron sparing surgery is the preferred treatment for small renal cortical masses. In patients amenable to extirpative therapy, partial nephrectomy (PN) is preferred. The effect of non-neoplastic parenchyma volume (NNPV) removed during PN on long-term renal function and local recurrence rates is unknown. We sought to determine the relationship between NNPV removed during partial nephrectomy and postoperative glomerular filtration rate (GFR) and local recurrence rates. Methods We queried the Columbia University Urologic Oncology Database to identify all patients undergoing PN from 1990 – 2012. GFR values were calculated using the CKD-EPI formula, and the percent change from preoperative to most recent follow-up value was calculated. The ellipsoid formula was used to calculate surgical specimen volumes (VS) and tumor volumes (VT), which were then subtracted from each other (VS - VT) to determine the NNPV removed. Linear regression analysis was performed to determine if the NNPV removed affected the percent change in post-operative GFR. Local recurrence was assessed based on review of post-operative imaging. Predictors of local recurrence were identified on logistic regression analysis and significant predictors were combined into a multivariate model. Results 464 patients underwent partial nephrectomy. Mean tumor volume was 14.8 cm3 (range 0.02 – 307.1 cm3). The average pre-operative and post-operative GFR was 90.84 (61.53 – 141.77) and 87.39 (9.63 – 129.61), respectively. The mean NNPV removed across all surgical modalities was 35.94 cm3. There was no statistical difference in the mean NNPV removed between the open (36.1 cm3), laparoscopic (35.2 cm3), and robotic (35.9 cm3) modalities. NNPV removed independently predicted post-operative GFR decline when controlling for: age, tumor volume, and stage (p = 0.035). NNPV removed was not found to be associated with local recurrence (p = 0.062). Conclusions There is a direct relationship between NNPV removed and GFR decline after PN. Additionally, the NNPV removed was not associated with local recurrence. Maximizing preservation of normal renal parenchyma in PN may offer superior long-term renal functional outcomes. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e490 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Srinath Kotamarti More articles by this author Michael B. Rothberg More articles by this author Matthew Danzig More articles by this author Shumaila Saad More articles by this author Jared Levinson More articles by this author Mitchell C. Benson More articles by this author James M. McKiernan More articles by this author Ketan K. Badani More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...