Philippe E. Spiess, MD, MS, associate member in the departments of genitourinary oncology and tumor biology at Moffitt Cancer Center in Tampa, FL, said the findings of this study are concerning and raise questions about increased hospitalizations and higher costs from AKI following RN and PN. However, he said much more research into this trend is warranted to uncover what is fueling it.
“One must be cautious in that this study was retrospective in its design, whereby it is not conclusive whether the patient populations [receiving RN or PN] were in fact similar in terms of baseline preoperative renal function and associated risks for AKI,” Dr Spiess told Cancer Therapy Advisor. “The results of this study should be assessed in a more rigorous, prospective study design using homogeneous inclusion criteria encompassing renal function and surgical criteria.”
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He said that although the results from this study will require further validation, more aggressive surgical management in patients with localized RCC may be creating this trend.
“There have been attempts to selectively operate in patients with small renal masses with the increased popularity of active surveillance and image-guided biopsy prior to proceeding with surgical intervention,” Dr Spiess explained. “If the results of this study are in fact corroborated in subsequent prospective studies, it would raise caution that a better assessment of preoperative renal function and risk of perioperative AKI be obtained and minimized in concert with optimization of reversible risk factors and with internal medicine and nephrology consultations.”
Urologic surgeon Robert Grubb III, MD, associate professor of surgery at the Washington University School of Medicine in St. Louis, MO, said this study adds to a growing body of literature from the past 15 years that looks at the relationship between renal surgery techniques and renal function. This literature, he noted, showed that nephron-sparing surgery was associated with improved preservation of renal function, compared with RN.
Dr Grubb said researchers have also looked at the utilization of nephron-sparing surgery and implementation of new surgical techniques for managing renal cancer. These include PR, laparoscopic RN, laparoscopic PN, robotic PN, and energy ablative techniques such as cryoablation and radiofrequency ablation. He said differential application of these techniques has been shown to vary by practice location, such as academic versus community and urban versus rural, and that socioeconomic factors may also be involved.
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“The variance in treatment across practice settings brings up issues of regionalization to centers of excellence where all treatment options can be considered,” Dr Grubb told Cancer Therapy Advisor. “These trends are overlaid on an aging population with an increasing incidence of renal cell cancer and increasing comorbidities that can add to the risk of AKI, such as hypertension, diabetes, and obesity.”
He also said that this study reinforces the fact that clinicians who are managing patients with renal masses must carefully evaluate each patient individually to determine their renal function and risk factors for postoperative AKI.
Reference
- Schmid M, Rafi P, Krishna N, et al. MP63-17 Trends of acute kidney injury after radical or partial nephrectomy for renal cell carcinoma. J Urol. 2016;193(4):e796.
