Partial Nephrectomy's Advantages Confirmed
Deterioration of kidney function after renal surgery is more significant in patients who have undergone radical nephrectomy (RN) rather than partial nephrectomy (PN), according to a Polish study.
In addition, the study showed that compensatory hypertrophy of the contralateral kidney seems not to be associated with hyperfunction. “The hypothesis regarding hyperfunction of the contralateral kidney should be revised because hyperfunction is not clinically or statistically significant,” the researchers concluded.
In a study comparing 33 RN patients and 18 PN patients, RN patients had a 32% decrease in estimated glomerular filtration rate (eGFR) one year postoperatively compared with just 5% in PN patients. Postoperatively, serum creatinine had increased in both groups, but significantly more so in the RN than the PN group. From baseline to 12 months postoperatively, serum creatinine values rose from 90.5 to 126.4 mmol/L in the RN group and from 89.4 to 95.1 in the PN group.
In addition, the mean effective plasma renal flow (EPRF) in the contralateral kidney increased by 4% in the RN patients and 0.1% in the PN patients. In the RN group, the EPRF in the contralateral kidney that was operated on decreased by 24.7%.
“Our results prompt one to question our current way of thinking about nephrectomy,” the authors, led by Slawomir Poletajew, MD, of the Medical Centre of Postgraduate Education in Warsaw, noted.
They also stated that their results “confirm the appropriateness of nephron-sparing surgery” and underscore “the inefficiency of potential compensatory mechanisms improving renal function in the postoperative period.”