The Effects of Radical Nephrectomy and Nephron Sparing Surgery on Glomerular Filtration Rate for the Patients who Underwent Surgery for Localized Renal Mass

INTRODUCTION: The goal of this study was to demonstrate the long-term effects of radical nephrectomy (RN) and nephron sparing surgery (NSS) on kidney functions.
METHODS: The medical records of 1016 patients who underwent kidney surgery from January 1990 to April 2011 at Hacettepe University School of Medicine, Department of Urology were retrospectively collected and analyzed. Metastatic 78 patients at presentation were excluded.
RESULTS: Radical nephrectomy and nephron sparing surgery was performed in 624 and 314 cases, respectively. Male to female ratio was 579/314. The mean follow up was 46.7 and 39.9 months for RN and NSS, respectively. The mean radiological tumor size was 75±33,5 mm for RN and 37,8±26 mm for NSS (p<0.001). The mean duration of surgery for RN and NSS was 137 and 139 minutes, respectively. The mean warm ischemia time for NSS was 18.9 minutes. Serum creatinin level was increased 0.51mg/dl and 0.39mg/dl for RN and NSS after long-term follow up, respectively (p<0.001). Glomerular filtration rate (GFR) was ≥ 60 ml/min/m2 in 47.6% and 74.8% of RN and NSS patients in long-term follow up, respectively (p<0.001).
DISCUSSION AND CONCLUSION: Decrease in GFR was more prominent in RN compared to NSS patients in long term. Therefore, removing the whole kidney for especially T1 renal tumours is over treatment in most cases. Partial nephrectomy should be preferred for all T1 renal tumours whenever technically feasible.

Lokalize Renal Kitle Nedeniyle Cerrahi Uygulanan Hastalarda Radikal Nefrektomi ile Nefron Koruyucu Cerrahinin Glomerüler Filtrasyon Oraný Üzerine Etkileri

GÝRÝÞ ve AMAÇ: Bu çalýþmada, radikal nefrektomi (RN) ile nefron koruyucu cerrahinin (NKC) uzun dönem böbrek fonksiyonlarý üzerine etkisini ortaya koymak amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Hacettepe Üniversitesi Týp Fakültesi Üroloji Anabilim Dalý’nda Ocak 1990 - Nisan 2011 tarihleri arasýnda renal kitle nedeniyle ameliyat edilen 1016 hastaya ait veriler, retrospektif olarak incelenmiþtir. Taný anýnda metastatik olduðu bilinen 78 olgu çalýþma dýþý tutulmuþtur.
BULGULAR: Çalýþmaya alýnan olgularýn 579'u (%61,7) erkek ve 359'u (%38,3) kadýndýr. 624 olguya RN, 314 olguya NKC yapýlmýþtýr. Hastalarýn ortalama takip süresi RN yapýlan grupta 46.7 ay iken, NKC uygulanan grupta 39.9 aydýr. Ortalama radyolojik tümör boyutu sýrasýyla 75±33,5 mm ve 37,8±26 mm’dir (p<0.001). Ortalama ameliyat süresi RN ve NKC gruplarý için sýrasýyla 137.6 ve 139.5 dakikadýr. NKC uygulanan grupta ortalama sýcak iskemi süresi 18,9±6,8 (3-36) dakikadýr. Uzun dönem takip sonunda RN yapýlan gruptaki kreatinin deðerindeki ortalama 0,51 mg/dl artýþ, NKC uygulanan gruptaki 0,39 mg/dl artýþtan anlamlý þekilde daha fazladýr (p<0.001). Uzun dönem takipte preoperatif GFR’ý ≥60 olan hastalarýn halen GFR deðerinin ≥60 olarak devam etme oranlarý, RN ve NKC yapýlan gruplarda sýrasýyla %47.6 ve %74.8 olarak tespit edilmiþtir (p<0.001).
TARTIÞMA ve SONUÇ: Çalýþmamýzda GFR’de azalma oranýnýn uzun dönemde RN yapýlan hastalarda NKC yapýlanlara göre daha fazla olduðu bulunmuþtur. T1 renal tümörü olan birçok olguda RN ile bütün böbreði çýkarmak fazladan tedavidir. T1 renal tümörü olan hastalarda teknik olarak mümkün oldukça parsiyel nefrektomi tercih edilmelidir.