Comparison of perioperative outcomes with or without renorrhaphy during open partial nephrectomy: A propensity score-matched analysis

Tachibana, Hidekazu; Takagi, Toshio; Kondo, Tsunenori; Ishida, Hideki; Tanabe, Kazunari

doi:10.1590/S1677-5538.IBJU.2016.0581

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Original Article • IBJUInt. braz j urol 44 (3) • May-Jun 2018 • https://doi.org/10.1590/S1677-5538.IBJU.2016.0581 copy

Comparison of perioperative outcomes with or without renorrhaphy during open partial nephrectomy: A propensity score-matched analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose:

Renorrhaphy in partial nephrectomy may damage intraparenchymal vessels and compress the renal parenchyma, which may lead to the formation of renal artery pseudoaneurysms or vascularized parenchymal volume reduction. Using propensity score matching, we compared surgical outcomes following non-renorrhaphy and renorrhaphy techniques for open partial nephrectomy (OPN) for T1a renal tumors.

Materials and Methods:

We retrospectively analyzed data from 159 patients with normal contralateral kidneys who underwent OPN for T1a renal tumors and pre- and postoperative enhanced computed tomography between 2012 and 2015. Patient variables were adjusted using 1:1 propensity score matching between the two Groups: renorrhaphy (inner and outer layer sutures) and non-renorrhaphy (inner layer sutures only). Postoperative complications and renal function were compared between the two groups.

Results:

We matched 43 patients per Group. Operative time, estimated blood loss, cold ischemic time, and postoperative hospital stay were not significantly different between the two Groups. Urine leakage (Clavien-Dindo grade ≥3) occurred in 0 renorrhaphy cases and 2 non-renorrhaphy cases (0% versus 4.6%, P=0.49). Renal artery pseudoaneurysm (RAP) occurred in 6 renorrhaphy cases and in 0 non-renorrhaphy cases (13% versus 0%, P=0.02).

Conclusions:

The non-renorrhaphy technique may result in a lower risk of RAP but a greater risk of urine leakage. This technique needs further refinement to become a standard procedure for OPN.

Keywords:
Kidney; Carcinoma; Renal Cell; Nephrectomy

	Pre-matching			Post-matching
	Renorrhaphy	Non-renorrhaphy	P-value	Renorrhaphy	Non-renorrhaphy	P-value
No. of cases	49	109		43	43
Age, years (range)	57 (31-80)	58 (27-82)	0.75	59 (33-80)	59 (27-82)	0.96
Sex (male/female)	34/15	73/36	0.85	30/13	32/11	0.63
Height, cm	166 (±7.3)	164 (±9.0)	0.03	166 (±7.4)	166 (±8.3)	0.91
Body weight, kg	67 (±12)	63 (±12)	0.04	65 (±11)	68 (±12)	0.81
No. of HT (%)	30 (61)	43 (39)	0.01	24 (55)	24 (55)	1.0
No. of DM (%)	12 (24)	22 (20)	0.53	10 (23)	8 (18)	0.59
Tumor size, mm (range)	28 (8-39)	30 (12-40)	0.30	28 (10-40)	29 (12-40)	0.84
Preoperative eGFR, mL/min/1.73 m²	66 (±17)	65 (±19)	0.91	64 (±17)	63 (±18)	0.73
Nephrometry score median (IQR)	8 (6-9)	9 (7-9)	0.12	8 (7-9)	8 (7-9)	0.84
R	1 (1-1)	1 (1-1)	0.19	1 (1-1)	1 (1-1)	0.56
E	2 (1-3)	2 (2-3)	0.55	2 (1-3)	2 (2-3)	0.76
N	2 (2-3)	2 (2-3)	0.22	3 (2-3)	3 (2-3)	0.87
A a/x/p	18/22/9	37/45/27	0.88	16/18/9	15/17/11	0.65
L	2 (1-3)	3 (2-3)	0.23	3 (2-3)	3 (2-3)	0.89

	Post-matching
	Renorrhaphy (n=43)	Non-renorrhaphy (n=43)	P-value
Operative time, min	194 (±43)	191 (±39)	0.72
Estimated blood loss, mL	175 (±282)	143 (±205)	0.54
Cold ischemia time, min	43 (±19)	38 (±18)	0.69
No. of positive surgical margin	0	1 (2.3%)	0.47
No. of urine leaks (%)
All	1 (2.3)	9 (20)	0.02
Clavien grade ≥ 3	0	2 (4.6)	0.49
No. of asymptomatic RAP (%)	6 (13)	0 (0)	0.02
Postoperative hospital stay, days	7.0 (±3.3)	6.0 (±2.4)	0.15
Postoperative eGFR (3 months later)	56 (±19)	61 (±19)	0.23
Postoperative decrease rate in eGFR, %	-12 (±20)	-2.2 (±13)	0.008

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[1] Correspondence address: Hidekazu Tachibana, MD Department of Urology Tokyo Women's Medical University 8-1, Kawada-cho, Shinjuku-ku Tokyo, 162-8666, Japan Fax: + 81 3 3356-0293 E-mail: tachi6ana@yahoo.co.jp