Ann Urol Res | Volume 5, Issue 1 | Research Article | Open Access
Ershad Hasan1*, Shamim Hossain1, Mohammad Abdus Salam1,2, Muhammed Serajul Islam1, Akterkamal Perveg1 and A K Al-Miraj3
1Department of Urology, BSMMU, Dhaka, Bangladesh
2Urology and Transplant Foundation of Bangladesh and Uro-Oncology, BSMMU, Dhaka, Bangladesh
3Department of Vascular Surgery, BSMMU, Dhaka, Bangladesh
*Correspondance to: Ershad HasanFulltext PDF
Background: Renal Cell Carcinoma (RCC) is the third most common malignancy of the genitourinary system characterized by lack of early warning clinical manifestations (asymptomatic) and late triad of symptoms (flank pain, hematuria, and palpable renal mass). It accounts for approximately 2% to 3% of the adult malignancy and 90% to 95% of neoplasm arising from the kidney. With the improvement in imaging technique, small and asymptomatic RCC is easily diagnosed and treated but advanced RCC is difficult to tract because its inherent resistance to conventional chemotherapy and radiotherapy. However, whether NSS is a better treatment than RN for RCCS still remains controversial. The recently published article reports that NSS substantially reduce the incidence of moderate renal dysfunction when compared with RN. Objective: To compare the time-dependent changes of estimated Glomerular Filtration Rate (eGFR) after nephron-sparing surgery and Radical Nephrectomy (RN) for Renal Cell Carcinoma (RCC). Type of study: Randomized controlled clinical trial. Place of study: Department of Urology, BSMMU and others institutes-National Institute of Kidney Disease and Urology (NIKDU), Dhaka Medical College Hospital (DMCH), Comfort Nursing Home (Pvt.) Ltd. Dhaka, during the period of January, 2017 to September 2018. Methods and Procedure: This prospective randomized controlled clinical trial study is conducted in the Department of Urology, BSMMU and other institutes-NIKDU, DMCH, Comfort Nursing Home (Pvt.) Ltd, Dhaka, from January, 2017 to September, 2018. Total 52 patients having renal cell carcinoma (<7 cm) and normal contralateral kidney, available preoperative and postoperative serum creatinine and MDRD-eGFR measurements are included in this study. Results: Demographic characteristics, BMI, pre and post operative symptoms and sign of the patients, most of the tumor characteristics (location, hydronephrosis and enhancement) are not statistically. Significant in both groups but statistically significant changes are found in tumor size (p=0.004) and tumor type (p=0.013). There is no significant difference in preoperative serum creatinine and eGFR in both groups but the time-dependent changes of eGFR after RN show plateau form initially and then gradually declining form the first postoperative day to the 12 postoperative months. In case of NSS, a lowest eGFR is observing in postoperative day I and gradually recovered to near preoperative level for 12 months. The mean (+DD) eGFR decreased more significantly in RN (group-B 18.56 ml/min) than NSS patients (group-A 6.31 ml/min) from preoperative to 12 months after operation and show statistically significant differences between and within both groups (p<0.001, <0.001 respectively). Conclusion: A Time dependent change of estimated Glomerular Filtration Rate (eGFR) after nephron-sparing surgery is better than Radical Nephrectomy (RN) for Renal Cell Carcinoma (RCC). NSS is therefore the better procedure for preservation of renal function.
Demographic Characteristics; BMI; Radical Nephrectomy (RN); Renal Cell Carcinoma (RCC); Postoperative symptoms
Hasan E, Hossain S, Abdus Salam M, Serajul Islam M, Perveg A, Al-Miraj AK. Renal Function after Nephron-Sparing Surgery vs. Radical Nephrectomy for Renal Cell Carcinoma: A Comparative Study. Ann Urol Res. 2021; 5(1): 1021..