Laparoscopic partial nephrectomy in patients with compromised renal function.

Objective: To present outcomes of laparoscopic partial nephrectomy (LPN) in patients with compromised baseline renal function.

Methods: Of 485 patients undergoing LPN between September 1999 and August 2005 at our institution, 48 (10%) had compromised baseline renal function, defined as serum creatinine 1.5mg/dL or greater (group I). Outcomes were compared with 437 patients undergoing LPN with normal baseline renal function (serum creatinine less than 1.5 mg/dL, group II). Both groups were compared regarding perioperative data, complications, and renal functional and oncologic outcomes.

Results: Group i patients were older (67.6 versus 58.6 years, P <0.001) and had higher American Society of Anesthesiologists scores (2.8 versus 2.4, P <0.001), higher Charlson Comorbidity Index (1.9 versus 0.7, P <0.001), and larger tumors (3.3 versus 2.7 cm, P = 0.01). Intraoperative data, postoperative outcomes, overall complications, and pathologic data were similar between groups. At a mean follow-up of 21 months, the deterioration in serum creatinine and estimated glomerular filtration rate was similar between groups (P = 0.99 and 0.89, respectively). Dialysis was required in 5 patients (10%) in group I and 3 patients (0.6%) in group II (P <0.001). Within group I, older patients (older than 70 years) with prolonged warm ischemia (greater than 30 minutes) had significantly worse renal functional outcomes. Comparing groups I and II, estimated 5-year overall survival was 78% versus 90% (log rank = 0.01) and cancer-specific survival was 100% versus 98% (log rank = 0.65).

Conclusions: Older patients with compromised renal function and warm ischemia time greater than 30 minutes are at high risk for renal dysfunction after LPN. Alternate nephron-sparing methods including hypothermia or probe-ablation should be considered in these patients.