Comprehensive Analyses of Factors Associated with Postoperative Renal Global Function in Patients Treated by Partial Nephrectomy
Advances in Surgical Sciences
Volume 7, Issue 1, June 2019, Pages: 21-28
Received: Feb. 8, 2019; Accepted: Mar. 14, 2019; Published: Apr. 8, 2019
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Takehiro Sejima, Department of Urology, Matsue City Hospital, Matsue, Japan
Toshihiko Masago, Department of Urology, YONAGO Medical Center, Yonago, Japan
Tetsuya Yumioka, Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan
Shuichi Morizane, Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan
Masashi Honda, Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan
Atsushi Takenaka, Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan
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Study aim: To characterize the associated factors of postoperative renal global functional deterioration after partial nephrectomy (PN), comprehensive analyses were performed using multiple factors categorized as data from pre, intra and postoperative periods. Methods: Ninety-three patients underwent PN. Estimated glomerular filtration rate (eGFR) and computed tomography (CT) scans were examined pre- and 6 months postoperatively. Renal global functional deterioration after PN was assessed by postoperative percent of eGFR decline. Pre- and postoperative renal parenchymal volume (RPV) was measured by the Synapse Vincent volumetric analyzer which creates a reconstructed image from a CT scan. Additional factors that were analyzed included patient demographics, comorbidities, surgical factors and tumor pathology. All factors demonstrating statistical tendencies (P < 0.1) in univariate analyses were subjected to multivariate logistic regression analysis. Two groups were categorized according to the degree of eGFR decline. Groups A and B were categorized as less than 15% and greater than 15% declines, respectively. Results: The case distributions of hypertension (HTN) and male gender were significantly shifted in group B. Significant compensatory renal hypertrophy of the contralateral side occurred postoperatively. The percent increment of RPV in the contralateral side in group B was significantly lower than that in group A. In multivariate analysis, HTN was the sole independent associated factor in group B. Conclusions: Host factors, rather than surgical factors, may be associated with postoperative renal global functional deterioration in PN. Surgeons should consider medical problems in addition to surgical skills especially in HTN patients.
Estimated Glomerular Filtration Rate, Partial Nephrectomy, Renal Function, Renal Volume
To cite this article
Takehiro Sejima, Toshihiko Masago, Tetsuya Yumioka, Shuichi Morizane, Masashi Honda, Atsushi Takenaka, Comprehensive Analyses of Factors Associated with Postoperative Renal Global Function in Patients Treated by Partial Nephrectomy, Advances in Surgical Sciences. Vol. 7, No. 1, 2019, pp. 21-28. doi: 10.11648/j.ass.20190701.15
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