| 1. |
- Bahi, R., et al.
(författare)
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Ischemia is not an independent predictive factor of chronic renal failure after partial nephrectomy in a solitary kidney in patients without pre-operative renal insufficiency
- 2015
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Ingår i: Progrès en urologie (Paris). - : Elsevier BV. - 1166-7087. ; 25:1, s. 27-33
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess the influence of vascular clamping and ischemia time on long-term post-operative renal function following partial nephrectomy (PN) for cancer in a solitary kidney.Patients and methods: This is a retrospective study including 259 patients managed by PN between 1979 and 2010 in 13 centers. Clamping use, technique choice (pedicular or parenchymal clamping), ischemia time, and peri-operative data were collected. Pre-operative and last follow-up glomerular filtration rates were compared. A multivariate analysis using a Cox model was performed to assess the impact of ischemia on post-operative chronic renal failure risk.Results: Mean tumor size was 4.0 ± 2.3 cm and mean pre-operative glomerular filtration rate was 60.8 ± 18.9 mL/min. One hundred and six patients were managed with warm ischemia (40.9%) and 53 patients with cold ischemia (20.5%). Thirty patients (11.6%) have had a chronic kidney disease. In multivariate analysis, neither vascular clamping (P = 0.44) nor warm ischemia time (P = 0.1) were associated with a pejorative evolution of renal function. Pre-operative glomerular filtration rate (P < 0.0001) and blood loss volume (P = 0.02) were significant independent predictive factors of long-term renal failure.Conclusion: Renal function following PN in a solitary kidney seems to depend on non-reversible factors such as pre-operative glomerular filtration rate. Our findings minimize the role of vascular clamping and ischemia time, which were not significantly associated with chronic renal failure risk in our study.
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| 2. |
- Pignot, G., et al.
(författare)
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L’Ischémie n’est pas un facteur d’insuffisance rénale chronique après néphrectomie partielle sur rein unique
- 2014
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Ingår i: Progrès en urologie (Paris). - : Elsevier. - 1166-7087. ; 24:13, s. 822-822
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Tidskriftsartikel (refereegranskat)abstract
- Objectifs Déterminer l‘influence du clampage pédiculaire et de sa durée sur la fonction rénale à long terme après néphrectomie partielle (NP) pour cancer sur rein unique.Méthodes L’étude a inclus rétrospectivement 259 patients opérés par NP entre 1979 et 2010 dans 13 centres. L’utilisation d’un clampage, son type (pédiculaire ou parenchymateux), sa durée ainsi que les données pré-, intra- et postopératoires ont été recueillies. Les valeurs de débit de filtration glomérulaire (DFG) préopératoire et au dernier suivi ont été comparés. Une analyse multivariée selon le modèle de Cox a été réalisée afin de déterminer l’impact de l’ischémie sur le risque d’insuffisance rénale (IR) chronique postopératoire.Résultats La taille moyenne des tumeurs était de 4,0±2,3cm et le DFG préopératoire moyen de 60,8±18,9ml/min. Au total, 106 patients ont été opérés en ischémie chaude (40,9 %) et 53 en ischémie froide (20,5 %). Trente patients (11,6 %) ont évolué vers l’insuffisance rénale chronique. En analyse multivariée, ni le clampage pédiculaire (p=0,44), ni la durée d’ischémie chaude (p=0,1) n’étaient associés à une évolution vers l’insuffisance rénale. Les facteurs indépendants d’insuffisance rénale à long terme étaient le DFG préopératoire (p<0,0001) et les pertes sanguines (p=0,02).Conclusion La fonction rénale après NP sur rein unique apparaît principalement liée à des facteurs non modifiables et notamment le DFG préopératoire. Ce travail relativise l’importance du clampage pédiculaire et du temps d’ischémie qui n’étaient pas significativement liés au risque d’IR dans notre étude.
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| 3. |
- Ravaud, Alain, et al.
(författare)
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Adjuvant Sunitinib in High-Risk Renal-Cell Carcinoma after Nephrectomy.
- 2016
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Ingår i: New England Journal of Medicine. - 0028-4793 .- 1533-4406. ; 375:23, s. 2246-2254
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Sunitinib, a vascular endothelial growth factor pathway inhibitor, is an effective treatment for metastatic renal-cell carcinoma. We sought to determine the efficacy and safety of sunitinib in patients with locoregional renal-cell carcinoma at high risk for tumor recurrence after nephrectomy.METHODS: In this randomized, double-blind, phase 3 trial, we assigned 615 patients with locoregional, high-risk clear-cell renal-cell carcinoma to receive either sunitinib (50 mg per day) or placebo on a 4-weeks-on, 2-weeks-off schedule for 1 year or until disease recurrence, unacceptable toxicity, or consent withdrawal. The primary end point was disease-free survival, according to blinded independent central review. Secondary end points included investigator-assessed disease-free survival, overall survival, and safety.RESULTS: The median duration of disease-free survival was 6.8 years (95% confidence interval [CI], 5.8 to not reached) in the sunitinib group and 5.6 years (95% CI, 3.8 to 6.6) in the placebo group (hazard ratio, 0.76; 95% CI, 0.59 to 0.98; P=0.03). Overall survival data were not mature at the time of data cutoff. Dose reductions because of adverse events were more frequent in the sunitinib group than in the placebo group (34.3% vs. 2%), as were dose interruptions (46.4% vs. 13.2%) and discontinuations (28.1% vs. 5.6%). Grade 3 or 4 adverse events were more frequent in the sunitinib group (48.4% for grade 3 events and 12.1% for grade 4 events) than in the placebo group (15.8% and 3.6%, respectively). There was a similar incidence of serious adverse events in the two groups (21.9% for sunitinib vs. 17.1% for placebo); no deaths were attributed to toxic effects.CONCLUSIONS: Among patients with locoregional clear-cell renal-cell carcinoma at high risk for tumor recurrence after nephrectomy, the median duration of disease-free survival was significantly longer in the sunitinib group than in the placebo group, at a cost of a higher rate of toxic events. (Funded by Pfizer; S-TRAC ClinicalTrials.gov number, NCT00375674 .).
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| 4. |
- Ljungberg, Börje, et al.
(författare)
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Guidelines on Renal Cell Carcinoma
- 2007
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Ingår i: European Association of Urology Guidelines. - : European Association of Urology. - 9789070244590 ; , s. 1-28
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 5. |
- Ljungberg, Börje, et al.
(författare)
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Guidelines on Renal Cell Carcinoma
- 2006
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Ingår i: European Association of Urology Guidelines. - : European Association of Urology. - 9070244373 ; , s. 1-26
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 6. |
- Verhoest, G, et al.
(författare)
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Predictive factors of chronic kidney disease stage V after partial nephrectomy in a solitary kidney : a multi-institutional study
- 2014
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Ingår i: Urologic Oncology. - : Elsevier. - 1078-1439 .- 1873-2496. ; 32:1, s. 28.e21-28.e26
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Partial Nephrectomy (PN) in a solitary kidney is at risk of chronic kidney disease (CKD) stage V and/or haemodialysis (HD). Our objective was to determine predictive factors of CKD stage V in this population. MATERIAL & METHODS: Data from 300 patients were retrospectively collected from 16 tertiary centres. Clinical and operative parameters, tumor characteristics and renal function before surgery were analyzed. Patients with and without CKD stage V (defined as MDRD<15ml/min) were compared using χ2 and Student-t tests for qualitative and quantitative variables, respectively. Predictive factors of CKD stage V were evaluated with a multivariable analysis using a Cox regression model. RESULTS: Median age and BMI were 63 years old and 26kg/m², respectively. Most of the patients (65%) were male with an anatomic solitary kidney (88.3%). Median tumor size was 4cm and 98% were malignant tumors. Median operative time, blood loss and clamping time were 180min, 350ml and 20min respectively. Renal cooling was used in 19.3% and clamping of the pedicle was performed in 61.6%. Twenty five patients (8.5%) presented post operative CKD stage V at last follow-up and 18 underwent HD (6%) post-operatively because of acute renal insufficiency. There was no difference between CKD stage V and non CKD stage V patients concerning Charlson index, operative time (180min vs 179min, p= 0.39), blood loss (475ml vs 350ml, p= 0.51), use of renal cooling and type of clamping. Patients with CKD stage V were older (70 vs 63 years old, p= 0.005), had a lower baseline renal function (clearance MDRD 41 vs. 62ml/min, p<0.0001) and an increased tumor size (p= 0.02). Complications occurred in 91 patients (30%) with 16% of minor (Clavien 1-2) and 14% of major (Clavien>2) complications, respectively. In multivariable analysis, baseline MDRD, BMI, and the occurrence of a minor complication were independent predictive factors of post operative CKD stage V. CONCLUSION: PN in a solitary kidney is at risk of post-operative CKD stage V and HD. Pre-operative altered renal function and post operative complications are the main predictive factors of permanent CKD stage V.
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