Journal de néphrologie et thérapeutique

Categorized Preoperative Estimated Glomerular Filtration Rate as a Criterion for Choosing Between Radical or Partial Nephrectomy for Renal Tumor

Abstract

Tsuyoshi Yamaguchi*,Takatsugu Okegawa,Eiji Higashihara,Kikuo Nutahara

Purpose: We examined retrospectively whether outcomes of radical nephrectomy (RN) and partial nephrectomy (PN) are predictable on the basis of preoperative estimated glomerular filtration rate (eGFR) classifications. Material and methods: The study included 284 patients with renal tumor who underwent RN (n=195) or PN (n=89) at our institution. Preoperative eGFRs were categorized to reflect the stages of chronic kidney disease (CKD). The primary endpoint was postoperative onset of CKD stage 3b (eGFR<45 mL/min/1.73 m2). Also examined were the incidence of postoperative cardiovascular (CV) events, overall survival (OS), and cause-specific survival (CSS). The outcomes of RN and PN were compared per the preoperative eGFR categories. Results: PN was found to prevent postoperative CKD ≥ stage3b when the preoperative eGFR indicated CKD stage 2. The incidence of CV events was significantly low among patients with an eGFR indicative of CKD stage 3a and treated by RN. Regardless of patients’ pre-operative eGFR, there was no significant difference between procedures in OS or CSS. Multivariate analysis showed RN to be an independent risk factor for CKD ≥ stage 3b in patients with a preoperative eGFR indicative of CKD stage 2. Conclusions: In terms of postoperative renal function and CV events, the prognosis is equivalent for PN and RN when preoperative eGFR indicates CKD stage 1. However, PN is advisable when preoperative eGFR indicates CKD stage 2, and RN may be the better option when preoperative eGFR indicates CKD stage 3a. Categorized preoperative eGFR can serve as a reliable criterion for choosing between RN and PN.