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Comparison of Renal Function between Robot-Assisted and Open Partial Nephrectomy as Determined by Tc 99m-DTPA Renal Scintigraphy.

Lee C, Kwon T, Yoo S, Jung J, Lee C, You D, Jeong IG, Kim CS - J. Korean Med. Sci. (2016)

Bottom Line: Multivariate analysis showed that greater preoperative renal unit function (P = 0.011) and nephrometry score (P = 0.041) were independently correlated with a reduction in glomerular filtration rate.The operative method did not correlate with renal function impairment (P = 0.704).Postoperative renal function impairment was similar between patients who underwent OPN and those who underwent RAPN, despite RAPN having a longer ischemic time.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea .

ABSTRACT
We compared postoperative renal function impairment between patients undergoing robot-assisted partial nephrectomy (RAPN) and those undergoing open partial nephrectomy (OPN) by using Tc-99m diethylenetriaminepentaacetic acid (DTPA) renal scintigraphy. Patients who underwent partial nephrectomy by a single surgeon between 2007 and 2013 were eligible and were matched by propensity score, based on age, tumor size, exophytic properties of tumor, and location relative to the polar lines. Of the 403 patients who underwent partial nephrectomy, 114 (28%) underwent RAPN and 289 (72%) underwent OPN. Mean follow-up duration was 35.2 months. Following propensity matching, there were no significant differences between the two groups in tumor exophytic properties (P = 0.818) or nephrometry score (P = 0.527). Renal ischemic time (24.4 minutes vs. 17.8 minutes, P < 0.001) was significantly longer in the RAPN group than in the OPN group, while the other characteristics were similar. Multivariate analysis showed that greater preoperative renal unit function (P = 0.011) and nephrometry score (P = 0.041) were independently correlated with a reduction in glomerular filtration rate. The operative method did not correlate with renal function impairment (P = 0.704). Postoperative renal function impairment was similar between patients who underwent OPN and those who underwent RAPN, despite RAPN having a longer ischemic time.

No MeSH data available.


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Change in GFR of the operated kidney, after propensity score matching.
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Figure 2: Change in GFR of the operated kidney, after propensity score matching.

Mentions: The demographic and clinical characteristics of the matched cohort are shown in Table 2. Unlike before matching, there were no significant group differences in the rates of exophytic tumors (P = 0.818) or nephrometry scores (P = 0.527). The propensity matched RAPN and OPN groups were similar in age, mass size, preoperative GFR of solitary renal units (41.8 mL/min/1.73 m2 vs. 42.8 mL/min/1.73 m2, P = 0.553), and renal function impairment (1.9 mL/min/1.73 m2 vs. 1.5 mL/min/1.73 m2, P = 0.806). Renal ischemic time (24.4 minutes vs. 17.8 minutes, P < 0.001) and operation time (216.9 minutes vs. 196.9 minutes, P < 0.001) were significantly longer in the RAPN group, but the hospital stay was overall significantly shorter (7.1 days vs. 8.4 days, P < 0.001) in the RAPN group. Complication rates did not differ significantly between the two groups (14.3% vs. 23.8%, P = 0.116). In the RAPN group, two patients required transfusion and one required angioembolization. In the OPN group, six patients required transfusion, one experienced wound dehiscence, and one required angioembolization. The RAPN group showed similar split renal function (33.6 mL/min/1.73 m2 vs. 33.7 mL/min/1.73 m2, P = 0.916) at 3 months and low split renal function at 1 year (34.4 mL/min/1.73 m2 vs. 37.8 mL/min/1.73 m2, P = 0.114) and 2 years (37.7 mL/min/1.73 m2 vs. 40.5 mL/min/1.73 m2, P = 0.264) after the operation, but showed no significant difference compared with OPN (Fig. 2). At 3 years after PN, both groups showed similar split renal function again (41.4 mL/min/1.73 m2 vs. 40.5 mL/min/1.73 m2, P = 0.788).


Comparison of Renal Function between Robot-Assisted and Open Partial Nephrectomy as Determined by Tc 99m-DTPA Renal Scintigraphy.

Lee C, Kwon T, Yoo S, Jung J, Lee C, You D, Jeong IG, Kim CS - J. Korean Med. Sci. (2016)

Change in GFR of the operated kidney, after propensity score matching.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4835600&req=5

Figure 2: Change in GFR of the operated kidney, after propensity score matching.
Mentions: The demographic and clinical characteristics of the matched cohort are shown in Table 2. Unlike before matching, there were no significant group differences in the rates of exophytic tumors (P = 0.818) or nephrometry scores (P = 0.527). The propensity matched RAPN and OPN groups were similar in age, mass size, preoperative GFR of solitary renal units (41.8 mL/min/1.73 m2 vs. 42.8 mL/min/1.73 m2, P = 0.553), and renal function impairment (1.9 mL/min/1.73 m2 vs. 1.5 mL/min/1.73 m2, P = 0.806). Renal ischemic time (24.4 minutes vs. 17.8 minutes, P < 0.001) and operation time (216.9 minutes vs. 196.9 minutes, P < 0.001) were significantly longer in the RAPN group, but the hospital stay was overall significantly shorter (7.1 days vs. 8.4 days, P < 0.001) in the RAPN group. Complication rates did not differ significantly between the two groups (14.3% vs. 23.8%, P = 0.116). In the RAPN group, two patients required transfusion and one required angioembolization. In the OPN group, six patients required transfusion, one experienced wound dehiscence, and one required angioembolization. The RAPN group showed similar split renal function (33.6 mL/min/1.73 m2 vs. 33.7 mL/min/1.73 m2, P = 0.916) at 3 months and low split renal function at 1 year (34.4 mL/min/1.73 m2 vs. 37.8 mL/min/1.73 m2, P = 0.114) and 2 years (37.7 mL/min/1.73 m2 vs. 40.5 mL/min/1.73 m2, P = 0.264) after the operation, but showed no significant difference compared with OPN (Fig. 2). At 3 years after PN, both groups showed similar split renal function again (41.4 mL/min/1.73 m2 vs. 40.5 mL/min/1.73 m2, P = 0.788).

Bottom Line: Multivariate analysis showed that greater preoperative renal unit function (P = 0.011) and nephrometry score (P = 0.041) were independently correlated with a reduction in glomerular filtration rate.The operative method did not correlate with renal function impairment (P = 0.704).Postoperative renal function impairment was similar between patients who underwent OPN and those who underwent RAPN, despite RAPN having a longer ischemic time.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea .

ABSTRACT
We compared postoperative renal function impairment between patients undergoing robot-assisted partial nephrectomy (RAPN) and those undergoing open partial nephrectomy (OPN) by using Tc-99m diethylenetriaminepentaacetic acid (DTPA) renal scintigraphy. Patients who underwent partial nephrectomy by a single surgeon between 2007 and 2013 were eligible and were matched by propensity score, based on age, tumor size, exophytic properties of tumor, and location relative to the polar lines. Of the 403 patients who underwent partial nephrectomy, 114 (28%) underwent RAPN and 289 (72%) underwent OPN. Mean follow-up duration was 35.2 months. Following propensity matching, there were no significant differences between the two groups in tumor exophytic properties (P = 0.818) or nephrometry score (P = 0.527). Renal ischemic time (24.4 minutes vs. 17.8 minutes, P < 0.001) was significantly longer in the RAPN group than in the OPN group, while the other characteristics were similar. Multivariate analysis showed that greater preoperative renal unit function (P = 0.011) and nephrometry score (P = 0.041) were independently correlated with a reduction in glomerular filtration rate. The operative method did not correlate with renal function impairment (P = 0.704). Postoperative renal function impairment was similar between patients who underwent OPN and those who underwent RAPN, despite RAPN having a longer ischemic time.

No MeSH data available.


Related in: MedlinePlus