Cancer - Kidney(구연) (E-094)

Comparison of Differential Functional outcome after Partial Nephrectomy between moderate (7-9) versus high complex (10-12) renal tumor evaluated with Diethylenetriamine pentaacetic acid scan - Propens
Urology, Seoul National University Bundang Hospital, Urology, Seoul National University Bundang Hospital, Urology, Seoul National University Bundang Hospital, Urology, Seoul National University Bundang Hospital, Urology, Seoul National University Bundang Hospital, Urology, Seoul National University Bundang Hospital, Urology, Seoul National University Bundang Hospital, Urology, Seoul National University Bundang Hospital
Hwanik Kim, Jung Kwon Kim, Jin Hyuck Kim, Joon Hyeok Choi, Sung Kyu Hong, Sangchul Lee, Hakmin Lee, Seok-Soo Byun
Background: In real world clinical setting, Partial Nephrectomy (PN) is not implemented frequently in RNS of 10 or more, and it is quite a burden and difficult to manage those patients related to postoperative (postop) complications. Renal function after PN is the result induced from a complex of clinical conditions including preoperative (preop) parenchymal quality, postop parenchymal quantity and the recovery of the remaining nephrons from the ischemic damages. However, the natural history and definitive predictors of long-term renal function after PN in RNS 7-9 (moderate complex, M) and RNS 10-12 (high complex, H) renal tumor still remain unclear and controversial.  / Objectives: Renal function preservation is the key rationale in support of partial nephrectomy (PN) over radical nephrectomy (RN) in renal mass management. Renal tumors with RENAL Nephrometry score (RNS) ≥10 are rarely treated with PN and role of PN for those tumors is not clarified. Therefore, we investigate to compare the functional outcome after PN in RNS≥10 from RNS 7-9. / Materials and Methods: In 2004/01-2019/12, 471 patients with RNS 7-9 (Moderate complex, M) and 164 patients with 10-12 (High complex, H) who underwent PN was analyzed for renal function outcomes. The glomerular filtration rate (GFR) measured from Diethylenetriamine pentaacetic acid (DTPA) scan and calculated GFR using the Modification of Diet in Renal Disease (MDRD) formula were compared between groups. Trifecta/Pentafecta outcome, recurrence free survival (RFS), and overall survival (OS) were also analyzed using propensity score matching analysis. / Results and Conclusion: Results: After propensity score matching, 156 cases in each group were matched with no significant difference of preoperative clinical factor. At postoperative (postop) 1st year, there was no significant difference in Trifecta (54.5% (M) vs 56.4%(H), p=0.320), MDRD-based (35.6% vs 33.6%, p=0.729) and DTPA-based Pentafecta achievement rate (28.6% vs 28.9%, p=0.964). At postop 5 year, DTPA-based total GFR, operated kidney GFR, contralateral kidney GFR preservation rate did not differ significantly (all p>0.05). Kaplan-Meier survival analysis showed no significant differences in survival outcomes between groups (all p >0.05). Significant predictors of de novo chronic kidney disease (CKD) stage≥3 at post 1st year are age (Hazard ratio (HR): 1.10 [1.03-1.17], p=0.005) and preoperative DTPA-based total GFR (HR: 0.94 [0.91-0.98], p=0.001). Conclusion: High complex renal tumor can be treated with partial nephrectomy without significant renal function deterioration. Postoperative operated kidney’s function is preserved up to 80% in the long term. Yet, for old-aged patients with low GFR, PN should be selectively performed with caution of occurrence of post CKD.
keywords : Differential functional outcome, high complex renal tumor, partial nephrectomy

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