Predictive Factors for Postoperative Decline in Renal Functions Following Partial Nephrectomy: Preliminary Results

Abstract

Objective:We aimed to determine the risk factors related to patient, tumor characteristics and surgery that may be associated with decline in renal function during follow-up after partial nephrectomy (PN).Materials and Methods:Sixty-one patients who underwent PN due to localized stage Ia renal cell carcinoma between January 2010 and October 2018 were retrospectively analyzed. Demographic characteristics of the patients, clinical and pathological data, information about surgical techniques, preoperative score to predict postoperative mortality (POSPOM), Age-adjusted Charlson Comorbidity index (ACCI), Eastern Cooperative Oncology Group score, American Society of Anesthesiologists’ score, preoperative estimated glomerular filtration rate (eGFR) and eGFR levels during postoperative follow-up were recorded.Results:Twelve (19.7%) patients experienced a decline in eGFR (<60 mL/min/1.73 m2) at the postoperative follow-up of median 30 months. Older age, higher Body Mass index, presence of hypertension, Diabetes Mellitus, tumor in the hilar region, higher scores of POSPOM, ACCI, RENAL and PADUA, lower preoperative eGFR, cold ischemia technique, total arterial clamping technique, longer warm ischemia time, longer cold ischemia time and lower preserved renal parenchymal volume (RPV) were found to be associated with both short- and long-term decline in eGFR (<60 mL/ min/1.73 m2).Conclusion:Although lower percentage of preserved RPV is a significant predictor of the postoperative deterioration of renal function, our results have shown that preoperative POSPOM score, ACCI and eGFR levels are just as important as surgical factors.

Keywords

• age-adjusted charlson comorbidity index
• estimated glomerular filtration rate
• partial nephrectomy
• pospom score
• preserved renal parenchymal volume
• renal cell carcinoma