Toward Individualized Approaches to Partial Nephrectomy: Assessing the Correlation Between Ischemia Time and Patient Health Status (RECORD2 Project).

Published on Aug 1, 2021in European Urology Oncology7.479
· DOI :10.1016/J.EUO.2020.05.009
Carlo Andrea Bravi10
Estimated H-index: 10
(UniSR: Vita-Salute San Raffaele University),
Andrea Mari32
Estimated H-index: 32
(UniFI: University of Florence)
+ 28 AuthorsAndrea Minervini41
Estimated H-index: 41
(UniFI: University of Florence)
Sources
Abstract
Abstract Background Ischemia time during partial nephrectomy (PN) is among the greatest determinants of acute kidney injury (AKI). Whether this association is affected by the preoperative risk of AKI has never been investigated. Objective To assess the effect of the interaction between the preoperative risk of AKI and ischemia time on the probability of AKI during PN. Design, setting, and participants Data of 944 patients treated with on-clamp PN for cT1 renal tumors were extracted from the Registry of Conservative and Radical Surgery for Cortical Renal Tumor Disease (RECORD2) database, a prospective multicenter project. Outcome measurements and statistical analysis We estimated the preoperative risk of AKI (defined according to the risk/injury/failure/loss/end-stage [RIFLE] criteria) according to age, baseline renal function, clinical stage, preoperative aspects and dimensions used for an anatomical (PADUA) score, and surgical approach. Classification and regression tree (CART) analysis identified patients at “high” and “low” risk of AKI. Finally, we plotted the probability of AKI over ischemia time stratified by the preoperative risk of AKI. Results and limitations Overall, 235 (25%) patients experienced AKI after surgery. At multivariable analysis, older patients, those with more complex tumors, those with higher baseline function, and those treated with open surgery had an increased risk of AKI (all p ≤ 0.011). According to the first split at CART analysis, patients were categorized as those with “high” and “low” risk of AKI having a probability of >40% or 20 min of ischemia was 13% versus 28% (absolute risk increase 15%). The risk of AKI for high-risk patients who had 20 min of ischemia was 31% versus 77%. This corresponds to an absolute risk increase of 45%. Limitations include retrospective data analyses and lack of surgeons’ prior experience. Conclusions Ischemia time during PN has different implications for patients with different health status. Clamp time seems less clinically relevant for patients in good conditions who may endure prolonged ischemia with a mild increase in the risk of AKI, whereas frail patients seem to be more vulnerable to ischemic damage even for short clamp time. For individualized intra- and postoperative management, duration of ischemia needs to be questioned in the context of the individual health status. Patient summary Functional sequelae related to ischemia time during partial nephrectomy depend on baseline health status. The correlation between the duration of ischemia and baseline health status should be taken into account toward individualized intra- and postoperative management.
References36
Newest
#1Alberto Martini (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 34
#2Ugo Falagario (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 10
Last. Ketan K. Badani (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 26
view all 9 authors...
Abstract Following partial nephrectomy (PN), it is important to prevent any deterioration in estimated glomerular filtration rate (eGFR). At present there are no evidence-based recommendations on when a nephrology consultation should be requested and how to adjust postoperative management when the risk of renal function decline is high. In an effort to address this void, we used our previously published nomogram to define risk groups for a significant decline in eGFR between 3–15 mo after PN. We...
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#1Carlo Andrea Bravi (UniSR: Vita-Salute San Raffaele University)H-Index: 10
#2Alessandro Larcher (UniSR: Vita-Salute San Raffaele University)H-Index: 31
Last. Andrea Minervini (UniFI: University of Florence)H-Index: 41
view all 30 authors...
Abstract Background Partial nephrectomy (PN) has a non-negligible perioperative morbidity. Comparative evidence of the available surgical techniques is limited. Objective To compare the perioperative outcomes of open, laparoscopic, and robotic PN. Methods Data of 2331 patients treated with PN for cT1 renal tumors were extracted from the RECORd2 database, a prospective multicenter project. Multivariable regression models assessed the relationship between surgical technique and surgical margins, w...
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#1Umberto Capitanio (UniSR: Vita-Salute San Raffaele University)H-Index: 63
#2Alessandro Larcher (UniSR: Vita-Salute San Raffaele University)H-Index: 31
Last. Roberto Bertini (UniSR: Vita-Salute San Raffaele University)H-Index: 32
view all 19 authors...
Abstract Background Despite better renal function following nephron-sparing surgery (NSS) relative to radical nephrectomy (RN), there is no consensus with respect to the long-term sequelae associated with surgery. Objective To investigate the effect of surgery and the temporal pattern of two different cardiovascular event (CVe) categories after NSS versus RN. Design, setting, and participants We collected data of 898 patients with cT1–2 N0 M0 renal mass and no history of CVe treated with NSS ver...
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#1Alessandro Antonelli (University of Brescia)H-Index: 27
#2Marco AllinoviH-Index: 13
Last. Andrea Minervini (UniFI: University of Florence)H-Index: 41
view all 17 authors...
Abstract Context Postoperative acute kidney injury (AKI) is a serious complication after kidney surgery, associated with prolonged hospital stay, high morbidity, and mortality. Biomarkers represent a tool of increasing importance to identify renal impairment after partial nephrectomy (PN) or radical nephrectomy (RN) in order to optimize and anticipate the diagnosis of AKI. Objective The goal of this systematic review is to investigate current insights on the role of biomarkers in predicting rena...
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#1Carlo Andrea Bravi (UniSR: Vita-Salute San Raffaele University)H-Index: 10
#2Andrew J. Vickers (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 126
We thank our colleagues for their interest in our paper assessing the association between acute kidney injury (AKI) during partial nephrectomy and renal function 1 year after surgery (1).
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#1Carlo Andrea Bravi (UniSR: Vita-Salute San Raffaele University)H-Index: 10
Source
#1Carlo Andrea Bravi (UniSR: Vita-Salute San Raffaele University)H-Index: 10
#2Emily Vertosick (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 23
Last. Andrew J. Vickers (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 126
view all 11 authors...
Abstract Background The relationship between acute kidney injury (AKI) and long-term renal function is controversial. The influence of AKI duration on functional recovery after partial nephrectomy has never been investigated. Objective To investigate the association between AKI and renal function 1 yr after partial nephrectomy, and whether this relationship is affected by the duration of AKI. Design, setting, and participants We analyzed the data of 1893 patients treated by partial nephrectomy f...
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#1Alberto Martini (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 34
#2John P. Sfakianos (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 27
Last. Ketan K. Badani (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 26
view all 8 authors...
Abstract Background Acute Kidney Injury (AKI) is a common occurrence after partial nephrectomy and is a significant risk factor for chronic kidney disease. We aimed to create a model that predicts postoperative AKI in patients undergoing robot-assisted partial nephrectomy (RAPN). Methods We identified 1,190 patients who underwent RAPN between 2008 and 2017 from a multicenter database. AKI was defined as a >25% reduction in eGFR from pre-RAPN to discharge. A nomogram was built based on a binary l...
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#1Andrea Mari (UniFI: University of Florence)H-Index: 32
#2Riccardo Campi (UniFI: University of Florence)H-Index: 19
Last. Andrea Minervini (UniFI: University of Florence)H-Index: 41
view all 30 authors...
OBJECTIVE: To identify meaningful predictors and to develop a nomogram of postoperative surgical complications in patients treated with partial nephrectomy (PN). PATIENTS AND METHODS: We prospectively evaluated 4308 consecutive patients who had surgical treatment for renal tumours, between 2013 and 2016, at 26 Italian urological centres (RECORd 2 project). A multivariable logistic regression for surgical complications was performed. A nomogram was created from the multivariable model. Internal v...
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#1Carlo Andrea Bravi (UniSR: Vita-Salute San Raffaele University)H-Index: 10
#2Amy Tin (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 9
Last. Andrew J. Vickers (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 126
view all 14 authors...
Purpose:Improved cancer control with increasing surgical experience (the learning curve) has been demonstrated for open and laparoscopic prostatectomy. We assessed the relationship between surgical...
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Cited By1
Newest
#1Petr MacekH-Index: 6
#2Xavier CathelineauH-Index: 52
Last. A R Rodriguez (Rochester General Health System)
view all 5 authors...
PURPOSE OF REVIEW To summarize current options available for robot-assisted partial nephrectomy RECENT FINDINGS: Partial nephrectomy (PN) is a standard treatment option for management of cT1 renal masses. It may be carried out by multiple approaches. Robot-assisted (RA) PN is one such option. The goal of treatment is both correct oncological (negative surgical margins) and functional (preservation of sufficient amount of renal parenchyma of the operated kidney) outcome. Appropriate outcomes depe...
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#1Andrea Mari (UniFI: University of Florence)H-Index: 32
#2Riccardo Tellini (UniFI: University of Florence)H-Index: 10
Last. Enrico Checcucci (UNITO: University of Turin)H-Index: 22
view all 22 authors...
Abstract null null Background null Robot-assisted partial nephrectomy (RAPN) is increasingly adopted for the treatment of localized renal tumors; however, rates and predictors of significant renal function (RF) loss after RAPN are still poorly investigated, especially at a long-term evaluation. null null null Objective null To analyze the predictive factors and develop a clinical nomogram for predicting the likelihood of ultimate RF loss after RAPN. null null null Design, setting, and participan...
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