Laparoscopic partial nephrectomy in patients with compromised renal function

OBJECTIVES 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 1). 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 1 and 3 patients (0.6%) in group II (P <0.001). Within group 1, 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.