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Evaluation of functional outcome of bilateral kidney tumors after sequential surgery

BACKGROUND: There are limited data concerning patients treated with sequential bilateral kidney surgery. Current guidelines still lack an optimal surgical sequencing approach. We evaluated renal functional outcomes after sequential partial nephrectomy (PN) and radical nephrectomy (RN) in patients wi...

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Autores principales: Kim, Jung Kwon, Kim, Hwanik, Lee, Hakmin, Oh, Jong Jin, Lee, Sangchul, Hong, Sung Kyu, Kwak, Cheol, Byun, Seok-Soo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8142506/
https://www.ncbi.nlm.nih.gov/pubmed/34024273
http://dx.doi.org/10.1186/s12885-021-08324-3
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author Kim, Jung Kwon
Kim, Hwanik
Lee, Hakmin
Oh, Jong Jin
Lee, Sangchul
Hong, Sung Kyu
Kwak, Cheol
Byun, Seok-Soo
author_facet Kim, Jung Kwon
Kim, Hwanik
Lee, Hakmin
Oh, Jong Jin
Lee, Sangchul
Hong, Sung Kyu
Kwak, Cheol
Byun, Seok-Soo
author_sort Kim, Jung Kwon
collection PubMed
description BACKGROUND: There are limited data concerning patients treated with sequential bilateral kidney surgery. Current guidelines still lack an optimal surgical sequencing approach. We evaluated renal functional outcomes after sequential partial nephrectomy (PN) and radical nephrectomy (RN) in patients with bilateral renal cell carcinoma (RCC). METHODS: A propensity score matched cohort of 267 patients (synchronous bilateral RCCs, N = 44 [88 lesions]; metachronous bilateral, N = 45 [90 lesions]; unilateral, N = 178) from two tertiary institutions were retrospectively analyzed. Synchronous bilateral RCCs were defined as diagnosis concomitantly or within 3 months of former tumor. Renal functional outcomes were defined as estimated glomerular filtration rate (eGFR) changes and de novo chronic kidney disease (CKD, stage ≥3) after surgery. Renal functional outcomes and clinical factors predicting de novo CKD were assessed using descriptive statistics and Cox regression analysis. RESULTS: In subgroup of bilateral RCCs, patients underwent sequential PN (N = 48), PN followed by RN (N = 8), or RN followed by PN (N = 25). Final postoperative estimated glomerular filtration rates (eGFRs) were 79.4, 41.4, and 61.2 ml/minute/1.73 m2, respectively (p = 0.003). There were significant differences in eGFR decline from baseline and de novo chronic kidney disease (CKD stage ≥ III) among groups, with PN followed by RN group showing the worst functional outcomes (all p <  0.05). Moreover, sequential PN subgroup in bilateral RCC showed significantly higher rate of de novo CKD than unilateral RCC group (13.8% vs. 6.9%, p = 0.016). On multivariate analysis, hypertension (p = 0.010) and surgery sequence (PN followed by RN, p <  0.001) were significant predictors of de novo CKD. CONCLUSIONS: The surgery sequence should be prudently determined in bilateral renal tumors. PN followed by RN showed a negative impact on renal functional preservation. Nephron-sparing surgery should be considered for all amenable bilateral RCCs. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12885-021-08324-3.
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spelling pubmed-81425062021-05-25 Evaluation of functional outcome of bilateral kidney tumors after sequential surgery Kim, Jung Kwon Kim, Hwanik Lee, Hakmin Oh, Jong Jin Lee, Sangchul Hong, Sung Kyu Kwak, Cheol Byun, Seok-Soo BMC Cancer Research BACKGROUND: There are limited data concerning patients treated with sequential bilateral kidney surgery. Current guidelines still lack an optimal surgical sequencing approach. We evaluated renal functional outcomes after sequential partial nephrectomy (PN) and radical nephrectomy (RN) in patients with bilateral renal cell carcinoma (RCC). METHODS: A propensity score matched cohort of 267 patients (synchronous bilateral RCCs, N = 44 [88 lesions]; metachronous bilateral, N = 45 [90 lesions]; unilateral, N = 178) from two tertiary institutions were retrospectively analyzed. Synchronous bilateral RCCs were defined as diagnosis concomitantly or within 3 months of former tumor. Renal functional outcomes were defined as estimated glomerular filtration rate (eGFR) changes and de novo chronic kidney disease (CKD, stage ≥3) after surgery. Renal functional outcomes and clinical factors predicting de novo CKD were assessed using descriptive statistics and Cox regression analysis. RESULTS: In subgroup of bilateral RCCs, patients underwent sequential PN (N = 48), PN followed by RN (N = 8), or RN followed by PN (N = 25). Final postoperative estimated glomerular filtration rates (eGFRs) were 79.4, 41.4, and 61.2 ml/minute/1.73 m2, respectively (p = 0.003). There were significant differences in eGFR decline from baseline and de novo chronic kidney disease (CKD stage ≥ III) among groups, with PN followed by RN group showing the worst functional outcomes (all p <  0.05). Moreover, sequential PN subgroup in bilateral RCC showed significantly higher rate of de novo CKD than unilateral RCC group (13.8% vs. 6.9%, p = 0.016). On multivariate analysis, hypertension (p = 0.010) and surgery sequence (PN followed by RN, p <  0.001) were significant predictors of de novo CKD. CONCLUSIONS: The surgery sequence should be prudently determined in bilateral renal tumors. PN followed by RN showed a negative impact on renal functional preservation. Nephron-sparing surgery should be considered for all amenable bilateral RCCs. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12885-021-08324-3. BioMed Central 2021-05-24 /pmc/articles/PMC8142506/ /pubmed/34024273 http://dx.doi.org/10.1186/s12885-021-08324-3 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Kim, Jung Kwon
Kim, Hwanik
Lee, Hakmin
Oh, Jong Jin
Lee, Sangchul
Hong, Sung Kyu
Kwak, Cheol
Byun, Seok-Soo
Evaluation of functional outcome of bilateral kidney tumors after sequential surgery
title Evaluation of functional outcome of bilateral kidney tumors after sequential surgery
title_full Evaluation of functional outcome of bilateral kidney tumors after sequential surgery
title_fullStr Evaluation of functional outcome of bilateral kidney tumors after sequential surgery
title_full_unstemmed Evaluation of functional outcome of bilateral kidney tumors after sequential surgery
title_short Evaluation of functional outcome of bilateral kidney tumors after sequential surgery
title_sort evaluation of functional outcome of bilateral kidney tumors after sequential surgery
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8142506/
https://www.ncbi.nlm.nih.gov/pubmed/34024273
http://dx.doi.org/10.1186/s12885-021-08324-3
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