Document Detail

Nephron-sparing Techniques Independently Decrease the Risk of Cardiovascular Events Relative to Radical Nephrectomy in Patients with a T1a-T1b Renal Mass and Normal Preoperative Renal Function.
MedLine Citation:
PMID:  25282367     Owner:  NLM     Status:  Publisher    
BACKGROUND: Some reports have suggested that nephron-sparing surgery (NSS) may protect against cardiovascular events (CVe) when compared with radical nephrectomy (RN). However, previous studies did not adjust the results for potential selection bias secondary to baseline cardiovascular risk.
OBJECTIVE: To test the effect of treatment type (NSS vs RN) on the risk of developing CVe after accounting for individual cardiovascular risk.
DESIGN, SETTING, AND PARTICIPANTS: A multi-institutional collaboration including 1331 patients with a clinical T1a-T1b N0 M0 renal mass and normal renal function before surgery (defined as an estimated glomerular filtration rate ≥60ml/min/1.73m(2)).
INTERVENTION: RN (n=462, 34.7%) or NSS (n=869, 65.3%) between 1987 and 2013.
OUTCOME MEASUREMENT AND STATISTICAL ANALYSES: CVe was defined as onset during the follow-up period of coronary artery disease, cardiomyopathy, hypertension, vasculopathy, heart failure, dysrhythmias, or cerebrovascular disease not known before surgery. Cox regression analyses were performed. To adjust for inherent baseline differences among patients, we performed multivariate analyses adjusting for all available characteristics depicting the overall and cardiovascular-specific profile of the patients.
RESULTS AND LIMITATIONS: When stratifying for treatment type, the proportion of patients who experienced CVe at 1, 5, and 10 yr was 5.5%, 9.9%, and 20.2% for NSS patients compared to 8.7%, 15.6%, and 25.9%, respectively, for RN patients (p=0.001). In multivariate analyses, patients who underwent NSS showed a significantly lower risk of developing CVe compared with their RN counterparts (hazard ratio 0.57, 95% confidence interval 0.34-0.96; p=0.03) after accounting for clinical characteristics and cardiovascular profile. Limitations include the retrospective design of the study because other potential confounders may exist.
CONCLUSIONS: The risk of CVe after renal surgery is not negligible. Patients treated with NSS have roughly half the risk of developing CVe relative to their RN counterparts. After accounting for clinical characteristics, comorbidities, and cardiovascular risk at diagnosis, NSS independently decreases the risk of CVe relative to RN.
PATIENT SUMMARY: The risk of having a cardiovascular event after renal surgery decreases if a portion of the affected kidney is spared.
Umberto Capitanio; Carlo Terrone; Alessandro Antonelli; Andrea Minervini; Alessandro Volpe; Maria Furlan; Rayan Matloob; Federica Regis; Cristian Fiori; Francesco Porpiglia; Ettore Di Trapani; Monica Zacchero; Sergio Serni; Andrea Salonia; Marco Carini; Claudio Simeone; Francesco Montorsi; Roberto Bertini
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-10-2
Journal Detail:
Title:  European urology     Volume:  -     ISSN:  1873-7560     ISO Abbreviation:  Eur. Urol.     Publication Date:  2014 Oct 
Date Detail:
Created Date:  2014-10-5     Completed Date:  -     Revised Date:  2014-10-6    
Medline Journal Info:
Nlm Unique ID:  7512719     Medline TA:  Eur Urol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.
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