Abstract
Objectives. To compare the incidence of newly developed chronic renal insufficiency after partial
nephrectomy (PN) and radical nephrectomy (RN). Elective PN for renal tumors is intended
to preserve renal function; however, studies of transplant donors suggest normal renal
function is also maintained after unilateral nephrectomy.
Methods. We retrospectively compared all patients undergoing PN or RN for renal tumors 4 cm
or less in the presence of a normal contralateral kidney from 1989 to 2000. Creatinine
failure was defined as a serum creatinine value greater than 2.0 mg/dL. Risk factors
for renal insufficiency, including diabetes, hypertension, American Society of Anesthesiologists
score, age, preoperative creatinine, and history of smoking tobacco, were compared
between the two groups. We compared the two groups using the chi-square and Mann-Whitney
U tests and the creatinine failure rates using the Kaplan-Meier method.
Results. One hundred seventy-three patients met the criteria for analysis after RN and 117
did so after PN (median follow-up 25 months). The 5-year freedom from recurrence rate
was 96.4% and 98.6% for PN and RN, respectively (P >0.05). The mean preoperative serum creatinine was 1.0 mg/dL (range 0.4 to 1.4) and
0.98 (range 0.6 to 1.5) for RN and PN, respectively (P = 0.4, not significant). The incidence of risk factors for renal insufficiency did
not differ between the two groups. The mean postoperative serum creatinine in the
RN and PN groups was 1.5 mg/dL (range 0.8 to 3.8) and 1.0 mg/dL (range 0.5 to 1.9),
respectively (P <0.001). The chance of creatinine failure over time was significantly greater in
the RN group (P = 0.008).
Conclusions. When controlled for preoperative risk factors for renal insufficiency, patients undergoing
RN are at a greater risk of chronic renal insufficiency than a similar cohort of patients
undergoing PN.
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Article Info
Publication History
Accepted:
December 13,
2001
Received in revised form:
December 13,
2001
Received:
May 9,
2001
Identification
Copyright
© 2002 Elsevier Science Inc. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Historical Perspective on Partial Nephrectomy and Renal Functional PreservationUrologyVol. 145
- PreviewIn this 2002 study from Memorial Sloan Kettering Cancer Center we evaluated the renal functional impact of partial nephrectomy (PN) or radical nephrectomy (RN) for renal tumors of 4 cm or less. We reported that RN patients were more likely to develop renal insufficiency as defined by a serum creatinine of > 2.0 mg/dL.1 This result confirmed similar findings reported from Mayo Clinic2 and both studies brought new concerns for the preservation of renal function into sharp focus for urologists performing kidney tumor operations.
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