Introduction

Partial nephrectomy is a common therapy for small renal masses and is associated with improved postoperative renal function when compared to radical nephrectomy. The highest quality prospective study of partial versus radical nephrectomy demonstrated worse overall survival in patients undergoing partial nephrectomy which appeared to be driven by cardiovascular outcomes. We examined patients undergoing partial and radical nephrectomy to assess for possible differential postsurgical hemodynamic effects.

Methods

An institutional renal mass database was queried for patients undergoing partial or radical nephrectomy between 2006 and 2012. Serial blood pressure followup, clinicopathologic variables and changes in medications including antihypertensives were collected. Patients were excluded for inadequate data, non-curative-intent surgery, non-cancer surgical indication and absence of medication information. Time-dependent changes in blood pressure were compared by split-plot ANOVA and addition or modification of antihypertensive regimen were studied as time-to-event survival analyses with Kaplan-Meier curves and a Cox proportional hazards model.

Results

Between 2006 and 2012, 402 partial nephrectomies and 205 radical nephrectomies were performed and a final cohort of 264 partial nephrectomy and 130 radical nephrectomy cases was identified with evaluable data. Patients undergoing partial nephrectomy were significantly younger, more likely to have T1 tumors, and had lower preoperative creatinine values (p < 0.001 for all). No differences were noted on postoperative systolic blood pressures, diastolic blood pressures and heart rates (p > 0.05) however, these analyses were underpowered on post-hoc analysis. Significantly more patients who underwent partial nephrectomy started new antihypertensive medications postoperatively (p = <0.001) and surgical treatment remained as a significant independent predictor on multivariate Cox regression (HR 2.51, p = 0.002).

Conclusions

Hemodynamic parameters after radical or partial nephrectomy may be different. The etiology of this observation, if any, is currently unexplored. Additional prospective mechanistic investigations are warranted.

Funding

None