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Abstract: SA-PO152

Characterization of Hemoglobin and Renal Function Trends After Reoperative Partial Nephrectomies in Patients With Recurrent Renal Cell Carcinoma (RCC)

Session Information

Category: Onconephrology

  • 1600 Onconephrology

Authors

  • Antony, Maria, National Cancer Institute, Bethesda, Maryland, United States
  • Gopal, Nikhil, National Cancer Institute, Bethesda, Maryland, United States
  • Blake, Zoe, National Cancer Institute, Bethesda, Maryland, United States
  • Gurram, Sandeep, National Cancer Institute, Bethesda, Maryland, United States
  • Ball, Mark, National Cancer Institute, Bethesda, Maryland, United States

Group or Team Name

  • Center for Cancer Research: Urologic Oncology Branch
Background

Patients with renal tumor syndromes may undergo multiple reoperative partial nephrectomies (RePN) conferring volume loss and functional sequelae. Though partial nephrectomy is oncologically safe and delays the need for renal replacement therapy compared to radical nephrectomy, few studies quantify outcomes in the reoperative setting. We studied a cohort of RePN to assess renal and hematologic outcomes following second, third-, and fourth-time partial nephrectomy of the same renal unit.

Methods

We performed a retrospective query of an institutional registry of nephrectomies for RCC in 2006 to 2021. Demographics, creatinine (SCr), and hemoglobin within one week prior to surgery were reviewed, as well as intraoperative blood loss. SCr was used to calculate eGFR using CKD-EPI 2021. Nephrectomy history was reconstructed based on documented surgical history between 1976 and 2021.

Results

Between 2006 and 2021, a total of 424 institutional nephrectomies (415 partial, 9 radical) conducted on 308 patients (60% male, 48 years old (IQR: 38-57)) were analyzed. Time between subsequent ipsilateral nephrectomy was 6.98 years (IQR: 4.4-10.5). We observed a stepwise decline in preoperative GFR with an average GFR decline of 6.3 with each RePN (p<0.001). Estimated blood loss (p=0.002) increased and hemoglobin decreased (p=0.006) with each RePN. On multivariate analysis, patients displayed odds of anemia with subsequent RePN at hemoglobin cut-off of 11 (OR:1.88, p<0.001) and 12 (OR:1.74, p<0.001) when controlling for gender, race, solitary kidney, and preoperative GFR.

Conclusion

RePN conveys renal functional decline, as well as increased intraoperative blood loss with each subsequent surgery. Our analysis suggests functional anemia is driven by partial nephrectomy frequency. Together, these impacts must be considered when counseling patients on available treatments to balance oncologic efficacy with prevention of chronic kidney disease and anemia.

Funding

  • Other NIH Support