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Open Access 01-12-2019 | Nephrectomy | Research article

Outcome of kidney function after ischaemic and zero-ischaemic laparoscopic and open nephron-sparing surgery for renal cell cancer

Authors: Jan Ebbing, Felix Menzel, Paolo Frumento, Kurt Miller, Bernhard Ralla, Tom Florian Fuller, Jonas Busch, Justin William Collins, Christofer Adding, Hans Helge Seifert, Peter Ardelt, Christian Wetterauer, Timm Westhoff, Carsten Kempkensteffen

Published in: BMC Nephrology | Issue 1/2019

Abstract

Background

Nephron-sparing surgery (NSS) remains gold standard for the treatment of localised renal cell cancer (RCC), even in case of a normal contralateral kidney. Compared to radical nephrectomy, kidney failure and cardiovascular events are less frequent with NSS. However, the effects of different surgical approaches and of zero ischaemia on the postoperative reduction in renal function remain controversial.

We aimed to investigate the relative short- and long-term changes in estimated glomerular filtration rate (eGFR) after ischaemic or zero-ischaemic open (ONSS) and laparoscopic NSS (LNSS) for RCC, and to analyse prognostic factors for postoperative acute kidney injury (AKI) and chronic kidney disease (CKD) stage ≥3.

Methods

Data of 444 patients (211 LNSS, 233 ONSS), including 57 zero-ischaemic cases, were retrospectively analysed. Multiple regression models were used to predict relative changes in renal function. Natural cubic splines were used to demonstrate the association between ischaemia time (IT) and relative changes in renal function.

Results

IT was identified as significant risk factor for short-term relative changes in eGFR (ß = − 0.27) and development of AKI (OR, 1.02), but no effect was found on long-term relative changes in eGFR. Natural cubic splines revealed that IT had a greater effect on patients with baseline eGFR categories ≥G3 concerning short-term decrease in renal function and development of AKI. Unlike LNSS, ONSS was significantly associated with short-term decrease in renal function (ß = − 13.48) and development of AKI (OR, 3.87). Tumour diameter was associated with long-term decrease in renal function (ß = − 1.76), whereas baseline eGFR was a prognostic factor for both short- (ß = − 0.20) and long-term (ß = − 0.29) relative changes in eGFR and the development of CKD stage ≥3 (OR, 0.89).

Conclusions

IT is a significant risk factor for AKI. The short-term effect of IT is not always linear, and the impact also depends on baseline eGFR. Unlike LNSS, ONSS is associated with the development of AKI. Our findings are helpful for surgical planning, and suggest either the application of a clampless NSS technique or at least the shortest possible IT to reduce the risk of short-time impairment of the renal function, which might prevent AKI, particularly regarding patients with baseline eGFR category ≥G3.

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Title: Outcome of kidney function after ischaemic and zero-ischaemic laparoscopic and open nephron-sparing surgery for renal cell cancer
Authors: Jan Ebbing
Felix Menzel
Paolo Frumento
Kurt Miller
Bernhard Ralla
Tom Florian Fuller
Jonas Busch
Justin William Collins
Christofer Adding
Hans Helge Seifert
Peter Ardelt
Christian Wetterauer
Timm Westhoff
Carsten Kempkensteffen
Publication date: 01-12-2019
Publisher: BioMed Central
Keywords: Nephrectomy
Acute Kidney Injury
Nephrectomy
Nephrectomy
Chronic Kidney Disease
Acute Kidney Injury
Published in: BMC Nephrology / Issue 1/2019
Electronic ISSN: 1471-2369
DOI: https://doi.org/10.1186/s12882-019-1215-3

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