Munich, Germany (UroToday.com) Patients who are diagnosed with renal masses often have chronic kidney disease. Preservation of kidney nephrons in this patient population is of great importance. The question often remains whether to perform radical or partial nephrectomy.
Derweesh and colleagues from University of California, San Diego performed a multi-center comparison of renal functional outcomes of robotic partial nephrectomy (RPN) and open partial nephrectomy (OPN) for patients with baseline CKD, and stratified functional outcomes according to RENAL nephrometry score.
A total of 525 patients from four academic institutions were recruited in this study. Primary outcome of the study was change in eGFR between preoperative last follow up value, stratified between RENAL nephrometry score groups. Secondary outcomes were eGFR decline at last follow up >50% from preoperative value, hemodialysis at last follow up and trifecta analysis.
Noticeably, mean tumor size and nephrometry scores was greater in OPN group compared to robotic group. Mean ischemia time was for robotic group (25 vs 33 mins). Mean blood loss as well as hospital stay was significantly shorter in robotic group. Open partial nephrectomy patients had significantly higher hemodialysis at last follow up compared to those patients who underwent robotic surgery. Most importantly, eGFR decline at last follow up was significantly less in robotic group (OR, 1.99, p=0.002).
In conclusion Dr. Derweesh stated that “Robotic partial nephrectomy should be considered as a first line treatment for the management of small renal masses in patients with pre-existing chronic kidney disease”. The data presented in this study fully supports this statement RPN can be safely performed with comparable renal function outcomes to OPN for appropriate patients.
Presented By:
Ithaar Derweesh, MD
University of California, San Diego. California, US.
From the 31st Annual EAU Congress - March 12 - 15, 2016 – Munich, Germany