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    Kidney Ca: Cytoreductive nephrectomy appears to be protective

     
    • In propensity-matched patients presenting with an estimated glomerular filtration rate (EGFR) between 30 and 60, the risk of progression to an EGFR <30 at 5 years was significantly lower following partial nephrectomy versus radical nephrectomy, and this translated to an improved overall survival for partial nephrectomy in this population. In a similar study, partial nephrectomy was found to be superior to radical nephrectomy for preventing progression to stage III chronic kidney disease (CKD).
    • A review of postoperative imaging results following partial nephrectomy revealed a very high rate of false positive studies in the first year that led to secondary testing. The authors concluded that the yield of early surveillance in this group did not justify the added burden and cost of care.
    • Patients with coronary artery disease are less likely to develop de novo CKD after renal surgery.
    • In a group of RCC patients, those who received perioperative transfusions had significantly poorer 5-year recurrence-free and overall survival. Separately, a review of 2010-2013 National Surgical Quality Improvement Program data found that perioperative transfusion substantially increased the rate of infection and early mortality. Both studies demonstrate an immunosuppressive role for transfusion and the need to minimize transfusion postoperatively.
    • In patients who underwent metastatectomy for sarcomatoid-variant versus non-sarcomatoid metastatic renal cancer, there was no survival benefit to surgery in this rare aggressive variant, particularly in the setting of lymph node disease.
    • A group 428 patients who had en bloc stapling of the renal hilum at time of laparoscopic nephrectomy demonstrated no arteriovenous fistula formation, with a mean follow-up of more than 3 years.
    • Continuation of perioperative clopidogrel (Plavix) therapy increased the risk of postoperative hemorrhage after partial nephrectomy nearly fourfold. In contrast, however, continuation of aspirin did not appear to increase postoperative hemorrhage risk.

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    Benjamin P. Saylor
    Saylor is content managing editor for Urology Times.

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