Comparison of the postoperative renal function between nephron-sparing surgery and radical nephrectomy

doi:10.3877/cma.j.issn.1674-3253.2017.06.009

Abstract

Abstract:

Objective

To compare the changes of renal function in patients with early localized renal cell carcinomaafter nephron sparing surgery and radical nephrectomy, and to explore the guiding role of different renal function indexes in clinical practice.

Methods

Clinical data and postoperative follow-up data of 63 patients with early renal tumor who received treatment in Nanjing Gulou Hospital between June 2013 and October 2014 were analyzed retrospectively. A total of 35 patients underwent nephron sparing surgery (Group NSS); 28 patients underwent radical nephrectomy (Group RN), and all the patients were followed up for two years. In addition, serum creatinine, uric acid, estimated glomerular filtration rate, cystatin C, urinary microalbumin and urinary β2microglobulin of these patients were collected and recorded during the follow-up period.

Results

Renal function of the 63 patients changed in different degrees after operation, and damaged more obviously in the early stage. With the extension of follow-up length, renal function of most patients could recover gradually. The incidence rate of postoperative acute renal insufficiency was 34%in Group NSS and 79% in Group RN, which presented statistically significant differences (P<0.01). The overall postoperative follow-up results showed there were statistically significant differencesin changes of estimated glomerular filtration rate, cystatin C and β2microglobulin (P<0.05), but no statistically significant differences in serum creatinine, uric acid and urinary microalbumin. Although levels of uric acid and microalbumin presented no statistically significant differences between the two groups, the average level in Group NSS was lower than that of Group RN. Early detection results of postoperative renal dysfunction showed the positive rate of independent detection of all indexes was low, especially the serum creatinine, uric acid, estimated glomerular filtration rate and other traditional renal function indexes. When the indexes were combined, the positive rate of renal dysfunction was significantly improved, and the combined positive rate was 37.1% and 71.4% in Group NSS and Group RN, respectively.

Conclusion

Nephron sparing surgery causes less damage to renal function in patients with early localized renal tumors than that of radical nephrectomy. Cystatin C, urinary microalbumin and urinaryβ2microglobulin are more sensitive to early detection ofpostoperative renal dysfunction, and may play a synergistic role with creatinine, uric acid and estimated glomerular filtration rate.

Key words: Renal cell carcinoma, Nephrectomy, Renal function

Liu Chao, Ning Liu, Weidong Gan, Weiqi Cai, Hongqian Guo. Comparison of the postoperative renal function between nephron-sparing surgery and radical nephrectomy[J]. Chinese Journal of Endourology(Electronic Edition), 2017, 11(06): 393-397.

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References 24

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组别	例数	性别（例）		年龄（岁）	肿瘤大小（cm）	肌酐（μmol/L）	GFR[ml/（min×1.73m²）]
组别	例数	男	女	年龄（岁）	肿瘤大小（cm）	肌酐（μmol/L）	GFR[ml/（min×1.73m²）]
保肾组	35	23	12	53±14	4.0±0.6	55±17	100±15
根治组	30	19	11	56±13	3.8±0.7	51±19	101±18
统计值	?	χ²=0.040		t=1.077	t=1.443	t=0.879	t=0.371
P值	?	0.841		0.286	0.154	0.383	0.712

组别	例数	性别（例）		年龄（岁）	肿瘤大小（cm）	肌酐（μmol/L）	GFR[ml/（min×1.73m²）]
组别	例数	男	女	年龄（岁）	肿瘤大小（cm）	肌酐（μmol/L）	GFR[ml/（min×1.73m²）]
保肾组	35	23	12	53±14	4.0±0.6	55±17	100±15
根治组	30	19	11	56±13	3.8±0.7	51±19	101±18
统计值	?	χ²=0.040		t=1.077	t=1.443	t=0.879	t=0.371
P值	?	0.841		0.286	0.154	0.383	0.712

时间	Scr	UA	eGFR	Cys C	mALB	β2-MG
术前	0.383	0.825	0.669	0.353	0.791	0.109
术后	0.321	0.153	0.007	0.011	0.252	0.009
术后2 d	<0.0010	0.049	<0.0010	<0.0010	0.001	<0.0010
术后6个月	0.356	0.410	0.356	0.287	0.679	0.136
术后12个月	0.614	0.047	0.487	0.111	0.884	0.770
术后18个月	0.634	0.102	0.024	0.208	0.732	0.014
术后2年	0.451	0.230	0.001	0.164	<0.0010	0.001

时间	Scr	UA	eGFR	Cys C	mALB	β2-MG
术前	0.383	0.825	0.669	0.353	0.791	0.109
术后	0.321	0.153	0.007	0.011	0.252	0.009
术后2 d	<0.0010	0.049	<0.0010	<0.0010	0.001	<0.0010
术后6个月	0.356	0.410	0.356	0.287	0.679	0.136
术后12个月	0.614	0.047	0.487	0.111	0.884	0.770
术后18个月	0.634	0.102	0.024	0.208	0.732	0.014
术后2年	0.451	0.230	0.001	0.164	<0.0010	0.001

组别	Scr	UA	eGFR	Cys C	mALB	β2-MG
保肾组	0.958	0.007	0.021	0.537	0.554	0.146
根治组	0.945	0.400	0.002	0.005	0.009	0.005

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