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Pierquet G, Zongo D, Robert G, Pasticier G, Maurice-Tison S, Bensadoun H, Ballanger P, Rouget B, Ferriere JM, Bernhard JC. [Partial nephrectomy on solitary kidney: Renal function outcome and predictive factors of impairment]. Prog Urol 2015; 26:34-40. [PMID: 26654468 DOI: 10.1016/j.purol.2015.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/10/2015] [Accepted: 09/29/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To assess the postoperative functional outcome of PN in solitary kidney and define some predictive factors of renal change. MATERIAL AND METHODS A monocentric series of 45 partial nephrectomies on solitary kidneys, performed between 1988 and 2014, was retrospectively analyzed. Pre-, per- and postoperative clinicopathological data were collected in the UroCCR database. The evolution of early, medium and long-term postoperative Glomerular Filtration Rate (GFR) was evaluated. Predictive factors of GFR decline and hemodialysis were assessed in multivariate analysis. RESULTS Mean age was 61 years old (±10.8). Mean preoperative GFR and tumor size were respectively 59.6 mL/min (±18.7) and 3.9 cm (±2.6). Vascular clamping was performed in 41 cases (91%). Median time of warm ischemia was 20 minutes (2-60). Mean follow-up was 66 months (±47). Mean GFR at day 5, 1 month and last follow-up were respectively 46.4 mL/min, 50.3 mL/min and 53.1 mL/min. At day 5 and at last follow-up, a GFR decrease ≥ 20% was found in 20 patients (44.4%) and in 16 patients (35.5%), respectively. Five patients (11%) required definitive hemodialysis (HD) at last follow-up. At day 5, tumor size>4 cm (0.006) and operative time (P=0.003) were independent predictive factors of GFR decline. At 1 year, RENAL ns ≥ 10 was the only independent predictive factor of GFR alteration (P=0.0007). Preoperative GFR was significantly associated with final hemodialysis (P=0.023). CONCLUSION Partial nephrectomy allows most of the patients presenting with renal cell carcinoma on solitary kidney to be free of hemodialysis. Tumor complexity, tumor size and preoperative GFR seems to play a determinant role on postoperative functional outcome. These non-modifiable predictive factors should be recognized and taken into account to better select patients with high risk of postoperative renal failure. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- G Pierquet
- Service d'urologie, andrologie et transplantation rénale, université de Bordeaux, CHU Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
| | - D Zongo
- ISPED, 33076 Bordeaux, France
| | - G Robert
- Service d'urologie, andrologie et transplantation rénale, université de Bordeaux, CHU Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - G Pasticier
- Service d'urologie, andrologie et transplantation rénale, université de Bordeaux, CHU Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | | | - H Bensadoun
- Service d'urologie, andrologie et transplantation rénale, université de Bordeaux, CHU Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - P Ballanger
- Service d'urologie, andrologie et transplantation rénale, université de Bordeaux, CHU Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - B Rouget
- Service d'urologie, andrologie et transplantation rénale, université de Bordeaux, CHU Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - J-M Ferriere
- Service d'urologie, andrologie et transplantation rénale, université de Bordeaux, CHU Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - J-C Bernhard
- Service d'urologie, andrologie et transplantation rénale, université de Bordeaux, CHU Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France; Réseau français de recherche sur le cancer du rein, 33076 Bordeaux, France
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Lecouteux A, Rigaud J, Glemain P, Le Normand L, Bouchot O, Karam G. [Imperative partial nephrectomy for renal cell carcinoma: oncological and functional results]. Prog Urol 2011; 21:599-606. [PMID: 21943655 DOI: 10.1016/j.purol.2011.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2010] [Revised: 03/10/2011] [Accepted: 04/22/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To study oncological results and functional results after partial nephrectomy in imperative indication for the treatment of renal cell carcinoma. PATIENTS AND METHODS From January 1990 to December 2009, 65 partial nephrectomies in 61 patients were performed in imperative indication for renal cell carcinoma. RESULTS The mean age of patients was 59.3 years. The mean follow-up was 47.4 months. The tumours were asymptomatic in 87.5%. The average tumour diameter was 4.3 cm. Twenty-nine percent of patients relapsed after a mean time of 27.4 months. The morbidity was 38.5%. Preoperative and endpoint serum creatinine and renal clearance were respectively 119 μmol/L and 63.1 mL/min versus 137 μmol/L and 50.9 mL/min (P=0.0003; 0.0002). Overall survival at one, three, five and ten years was 98.4%, 91.2%, 91.2% and 51.9%. CONCLUSION Partial nephrectomy in imperative indication for renal cell carcinoma has helped preserve renal function but has a significant morbidity and recurrence rate.
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Affiliation(s)
- A Lecouteux
- Clinique urologique, CHU de Nantes, place Alexis-Ricordeau, Nantes, France.
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[Complex renal tumors on solitary kidney: results of ex vivo nephron-sparing surgery with autotransplantation]. Prog Urol 2010; 20:194-203. [PMID: 20230941 DOI: 10.1016/j.purol.2009.10.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Revised: 10/22/2009] [Accepted: 10/28/2009] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To analyze the complications and the oncologic and functional results after ex vivo surgery and autotransplantation for the treatment of complex renal tumors. MATERIAL AND METHOD From 1996 to 2009, 11 patients, mean age 54.8 years, underwent ex vivo nephron-sparing surgery and autotransplantation for malignant complex renal tumors (centrorenal or hilar topography) on an anatomic or functional solitary kidney. Three patients (27.2 %) were treated for a metastatic disease. RESULTS Mean operative time was 340 minutes (240-440) and mean ischemia time was 162 minutes (110-231). Five patients (45.4 %) needed peroperative blood transfusion. Mean hospital stay was 21.5 days (8-50). Eight patients (72.7 %) suffered complications: two urinary fistulas, two early vascular thrombosis leading to nephrectomy and permanent dialysis, two pneumopathies and four acute tubular necrosis leading to temporary dialysis. There was no death among patients in early postoperative period. Tumors TNM staging ranged from pT1 to pT3aN0. Surgical positive margins were observed in three cases (27.2 %). With a mean follow-up of 37.8 months (3-144), the mean MDRD creatinine clearance was of 45.4 ml/min/1.73 m(2) and four patients (36.4 %) were presenting a complete remission. We observed two local recurrences (18.2 %) and five metastatic evolutions (45.4 %) leading to two deaths (18.2 %). CONCLUSION Ex vivo nephron-sparing surgery was an acceptable option in the treatment of complex renal tumors for imperative indications, when in situ surgery appeared to be technically unfeasible. Despite a significative morbidity, long-term functional results were satisfying.
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