INTRODUCTION & OBJECTIVES: Previous studies assessed predictors of kidney failure after partial nephrectomy. However, evidence is scarce regarding the impact of preoperative patient characteristics on the risk of renal failure after Robot-Assisted Partial Nephrectomy (RAPN) in patients with Renal Cell Carcinoma (RCC) and normal preoperative renal function. MATERIAL & METHODS: We evaluated 243 patients treated with RAPN for RCC at 10 worldwide centers between 2008 and 2013 included in the Vattikuti Global Quality Initiative in Robotic Urologic Surgery (GQI-RUS) database. All patients included in the study had normal preoperative kidney function, as defined by an estimated GFR (eGFR) ≥90 mL/min/1.73m2. Renal failure after RAPN was defined as a decrease in the eGFR ≥25%. Uni- and multi variable logistic regression analyses assessed the impact of preoperative patient and disease characteristics on the risk of renal failure after surgery. In particular, covariates consisted of age at surgery, preoperative eGFR, PADUA score, Charlson co morbidity index, and gender. RESULTS: Median age at surgery was 51 years. Median preoperative eGFR and BMI were 103 mL/min/1.73m2 and 29, respectively. Median PADUA score and clinical tumour size were 8 and 34.0 mm, respectively. Overall, 153 (63.0%) vs. 90 (37.0%) patients were male vs. female, respectively. Overall, 99 (40.7%) patients experienced kidney failure immediately after RAPN. In uni variable analyses, age at surgery, PADUA-score and baseline eGFR were significantly associated with the risk of postoperative kidney failure (all P<0.01). In multi variable analyses, older age (Odds Ratio [OR]: 1.05; 95% confidence interval [CI]: 1.01-1.11; P=0.04) and higher PADUA-score (OR: 1.34; 95% CI: 1.02-1.78; P=0.04) represented independent predictors of kidney failure after RAPN. CONCLUSIONS: Age and PADUA-score represent independent preoperative predictors of kidney failure after RAPN in patients with RCC and normal kidney function. These parameters should be considered when planning the surgical approach and counselling patients with regards to the risk of renal surgery.
|Titolo:||Preoperative predictors of renal failure after robot-assisted partial nephrectomy: Analysis of the Vattikuti Global Quality Initiative in Robotic Urologic Surgery (GQI-RUS) database|
|Data di pubblicazione:||2016|
|Appare nelle tipologie:||1.5 Abstract in rivista|