ABSTRACT
PURPOSE: We assessed the predictive factors for renal insufficiency in patients followed for more than 5 years after radical nephrectomy. MATERIALS AND METHODS: Age, gender, history of diabetes, history of hypertension, body mass index, preoperative estimated glomerular filtration rate (eGFR), serum uric acid, urine albumin, normal renal parenchymal volume, tumor size, and ratio of normal parenchymal volume of the removed kidney to that of the remaining kidney were evaluated retrospectively in 89 patients who underwent radical nephrectomy from January 2001 to December 2005. Patients were included whose renal parenchymal volume was measurable by use of perioperative imaging (computed tomography or magnetic resonance imaging), whose preoperative eGFR was greater than 60 mL/min/1.73 m(2), and who were followed for more than 5 years. To measure renal parenchymal volume from imaging, we integrated the extent of the normal renal parenchyma from axial slides of images. RESULTS: In univariate and multivariate binary regression analysis, the parenchymal volume of the remnant kidney (p=0.001), a history of diabetes (p=0.035), and preoperative eGFR (p=0.011) were independent factors for renal insufficiency. By use of a receiver operating characteristic curve, a volume of 170 mL was determined to be an appropriate cutoff value, with sensitivity of 58.7% and specificity of 74.4% for the parenchymal volume of the remnant kidney for predicting eGFR less than 60 mL/min/1.73 m(2) (area under the curve, 0.678). The parenchymal volume of the remnant kidney was also an independent factor for the downgrading of the chronic kidney disease category in the multivariate linear regression analysis (p=0.021). CONCLUSIONS: Preoperative eGFR, a history of diabetes, and the radiologic volume of the remaining kidney parenchyma could be useful factors for predicting postoperative renal function. Patients with parenchymal volumes of less than 170 mL have a higher risk of postoperative renal insufficiency, which should be considered carefully when choosing a treatment modality.
ABSTRACT
PURPOSE: The aim of our study was to compare early complication rates between the robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC) using a standardized reporting system. PATIENTS AND METHODS: From September 2008 to March 2011, 35 and 104 patients underwent ORC and RARC, respectively. Demographics and perioperative and complication data on all patients were reviewed retrospectively and compared between the two groups. All complications were categorized using a modified Clavien reporting system. We also sought to identify independent predictive factors of grade II or greater complications. RESULTS: There were no significant differences between the ORC and RARC groups with regard to age, body mass index, American Society of Anesthesiologists score, clinical stage, surgical procedure history, or sex. The RARC group had more cases of ileal neobladder urinary diversion (P<0.001). We did not find any differences in terms of pathologic stage or length of stay. The ORC group had more grade II or greater complications (P=0.001), wound problems (P=0.043), multiple complications (P=0.014), greater estimated blood loss (EBL) (P<0.001), and needed more transfusions (P<0.001). A longer operative time was needed in the RARC group, however. Multivariate logistic regression analysis demonstrated that the ORC (P=0.045, odds ratio [95% confidence interval]=2.44 [1.02-5.85]), EBL (>500 mL, P=0.013, 2.75 [1.24-6.10]), and female sex (P=0.028, 4.06 [1.12-14.11]) were independent predictors of grade II or greater complications. CONCLUSIONS: Our results showed that the RARC group was comparable to the ORC group with respect to complications using the Clavien reporting system. Further long-term and randomized trials are needed, however, because RARC is still not considered the standard therapy for bladder cancer.
