RENAL FUNCTIONAL STATUS AFTER NEPHRON-SPARING SURGERY VERSUS RADICAL NEPHRECTOMY FOR RENAL CELL CARCINOMA: A RANDOMIZED CLINICAL TRIAL STUDY

Dr. SM Ramiz Ahmed*, Dr. Md. Abdul Quiyum, Dr. Mohammad Zahirul Islam, Dr. Md. Mostafa Kamal, Dr. Nirupom Mondal and Dr. Md. Tazrul Islam

ABSTRACT

Introduction: Localized RCC can be managed by surgery, ablative therapy and active surveillance. Radical nephrectomy (RN) has long been the standard treatment for renal cell carcinoma (RCC). Whether NSS is a better than RN for RCC still remains controversial. Evaluate the renal function changes in the follow up period after NSS and RN for RCC can be done with various method including by MDRD-eGFR preoperatively and postoperatively. Objective: To compare estimated glomerular filtration rate (eGFR) after nephron-sparing surgery and radical nephrectomy (RN) for renal cell carcinoma (RCC). Methods: We evaluated renal function of NSS and RN in 52 patients having renal cell carcinoma (≤7 cm, cT1b) and normal contralateral kidney using eGFR in different hospitals and institutes, Dhaka, from January, 2017 to September, 2018. After surgical intervention with different surgeons, MDRD-eGFR was measured postoperatively 1, 3, 7 days, and 3 monthly for one year. MDRD-eGFR declining is assessed from the preoperative value (eGFR0) to the last post operative value (eGFR12) at the end of follow up. Results: Demographic characteristics, BMI, pre and post operative symptoms and sign of the patients, most of the tumor characteristics were 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 eGFR in both groups. The mean eGFR decreased more significantly in RN (18.56 ml/min) than NSS patients (6.31 ml/min) from preoperative to 12 months after operation and shows statistically significant differences between and within both groups (p <0.001, <0.001, 0.001 respectively). Conclusion: NSS is the superior protective technique for improving renal function than RN for RCC.

Keywords: RCC, redical nephrectomy, nephron sparing surgery, MDRD, eGFR.