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Comparison of Differential Functional Outcomes After Partial Nephrectomy Between Moderate and High Complex Renal Tumor Evaluated with Diethylenetriamine Pentaacetic Acid Scan: A Propensity Score Matched Analysis

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Objective

The aim of this study was to compare functional outcomes after partial nephrectomy (PN) between moderate and high complex renal tumors evaluated with a diethylenetriamine pentaacetic acid (DTPA) scan [moderate vs. high: RENAL nephrometry score (RNS) 7–9 vs. 10–12].

Methods

From January 2004 to December 2019, 471 patients with an RNS of 7–9 (moderate) and 164 patients with an RNS of 10–12 (high) who underwent PN were analyzed for renal function outcomes. The glomerular filtration rate (GFR) was measured using a DTPA scan and calculated the GFR using the Modification of Diet in Renal Disease (MDRD) formula, respectively. Trifecta/pentafecta outcome, recurrence-free survival, and overall survival were compared after propensity score matched analysis (PSMA).

Results

After PSMA, 156 cases in each group were matched without significant difference in the preoperative factor. At the postoperative first year, there was no significant difference in the trifecta (p = 0.320), MDRD-based (p = 0.729), or DTPA-based pentafecta achievement rate (p = 0.964) between groups. At postoperative 5 years, DTPA-based total GFR (93.6% vs. 93.8%) and the operated kidney GFR preservation rate (89.9% vs. 81.7%) did not differ significantly (p > 0.05). Kaplan–Meier survival analysis showed no significant differences in survival outcomes (p > 0.05). Significant predictors of de novo chronic kidney disease (CKD) stage 3 or higher at the postoperative first year were age [hazard ratio (HR) 1.10, 95% confidence interval (CI) 1.03–1.17, p = 0.005] and preoperative DTPA-based total GFR (HR 0.94, 95% CI 0.91–0.98, p = 0.001).

Conclusion

High complex tumors can be treated with PN without significant deterioration in renal function. The postoperative function of the operated kidney was preserved by up to 80% in the long term compared with the preoperative period. However, PN should be selectively performed with caution to avoid the occurrence of postoperative CKD.

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Authors and Affiliations

  1. Department of Urology, Seoul National University Bundang Hospital, Seongnam, South Korea

    Hwanik Kim MD, Jung Kwon Kim MD, PhD, Jin Hyuck Kim MD, Sangchul Lee MD, PhD & Hakmin Lee MD, PhD

  2. Department of Urology, Seoul National University Bundang Hospital & Seoul National University College of Medicine, Seongnam, South Korea

    Sung Kyu Hong MD, PhD & Seok-Soo Byun MD, PhD

  3. Department of Chemistry, School of Arts and Science, Boston College, Chestnut Hill, MA, USA

    Joon Hyeok Choi

Authors
  1. Hwanik Kim MD
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  2. Jung Kwon Kim MD, PhD
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  3. Jin Hyuck Kim MD
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  5. Sung Kyu Hong MD, PhD
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  6. Sangchul Lee MD, PhD
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  8. Seok-Soo Byun MD, PhD
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Contributions

HK and SSB contributed to protocol/project development; JHK, JHC, SKH, SL, HL, and SSB were involved in data collection or management; HK, JKK, JHC, and SSB analyzed the data; HK, JKK, and SSB contributed to manuscript writing/editing; and HK, JKK, and SSB were involved in critical review. SSB supervised the study.

Corresponding author

Correspondence to Seok-Soo Byun MD, PhD.

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Disclosures

Hwanik Kim, Jung Kwon Kim, Jin Hyuck Kim, Joon Hyeok Choi, Sung Kyu Hong, Sangchul Lee, Hakmin Lee, and Seok-Soo Byun have no conflicts of interest to declare, including specific financial interests, relationships, and affiliations, relevant to the subject materials described in this manuscript.

Ethical Statements

All study protocols were in accordance with the principles of the Helsinki Declaration. We removed personal identifiers and anonymized all data, which exempted the study from the need to obtain informed consent from patients.

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Kim, H., Kim, J.K., Kim, J.H. et al. Comparison of Differential Functional Outcomes After Partial Nephrectomy Between Moderate and High Complex Renal Tumor Evaluated with Diethylenetriamine Pentaacetic Acid Scan: A Propensity Score Matched Analysis. Ann Surg Oncol 29, 1476–1485 (2022). https://doi.org/10.1245/s10434-021-10718-3

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  • DOI: https://doi.org/10.1245/s10434-021-10718-3

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