Functional outcomes of the radical nephrectomy in patients with clinically localized kidney cancer

Volkova M.I., Skvorcov I.Ya., Klimov A.V., Komarov M.I., Chernyaev V.A., Matveev V.B.

Aim of the study: to evaluate the functional outcomes of the radical nephrectomy in patients with clinically localized kidney cancer (acute deterioration of the kidney function (ADKF) and the necessity of the acute dialysis (AD) in early (≤28 days) post-operative period, development of chronic kidney disease (CKD) ≥ stage 3 and rapid decrease in the glomerular filtration rate (GFR) in late (>28 days) post-operative period).

Materials and methods: this study was based on the information from 426 patients with clinically localized kidney cancer (cT1-2N0M0), which underwent the radical nephrectomy in years 1991-2011. The median age was 57 years. The female to male ratio was 1.1:1. The median tumor size was 5.0 cm. The concurrent diseases undermining the renal function were present in 32.6%, adiposity – in 39.4%. The renal function was estimated using the GFR calculation. The median follow-up was 50.0 months.

Results: the incidence of ADKF was 25.8% (with the necessity of AD – 2.1%), CKD with stage ≥3 – 40.8% (with rapid decrease in GFR – 2.8%). Regression analysis showed that GFR< 60 and the presence of concurrent diseases, which were able to deteriorate the functional activity of the lasting nephrons (age ≥ 60, diabetes mellitus, arterial hypertension, adiposity), were significant predictors of the unfavorable outcome of the treatment for renal function. CKD ≥ stage 3 were significantly more oft to occur, when the tumor size was ≤ 4 cm and in the presence of ADKF early post-op.

Conclusions: functional results of the radical nephrectomy are suboptimal, which warrants the necessity to carefully identify the indications to this kind of surgery in patients with clinically localized kidney cancer.

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