814 VARIATIONS IN INCIDENCE OF AND RISK FACTORS FOR DEVELOPMENT OF DIABETES MELLITUS AFTER RADICAL OR PARTIAL NEPHRECTOMY

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THE JOURNAL OF UROLOGY姞

the groups. Mean SF12 score was similar between AS and intervention groups at enrollment (95.1 vs. 96.2, p⫽0.4); SF12 was significantly better for intervention at 6 months (100.7 vs. 92.2, p0.03). For those electing surgery, 46 (60.5%), 12 (15.8%) and 18 (23.7%) underwent partial nephrectomy (PN), radical nephrectomy and renal cryoablation respectively. 10 (13.5%) PN were performed open, 6 (8.1%) cryoablations were performed percutaneously; the remainder of cases were done laparoscopically. Of the treated masses, 51 were RCC. Of the 22 benign masses, 9 (12.3%) were oncocytoma, 4 (5.4%) were AML. Of the 20 patients who underwent surgery with a positive growth rate and the 7 patients with growth rates ⬎0.5cm/year, pathology was RCC in 14 and 4 respectively. With a median follow-up of 5.7 months, there have been no recurrences, progressions or deaths. CONCLUSIONS: With short term follow-up in a registry of patients with SRM, just over 60% selected intervention versus AS. Quality-of-life is significantly better at 6 months for those who undergo intervention. 70% of masses removed were malignant, however recurrence and progression free survival are excellent with short follow-up. Source of Funding: None

814 VARIATIONS IN INCIDENCE OF AND RISK FACTORS FOR DEVELOPMENT OF DIABETES MELLITUS AFTER RADICAL OR PARTIAL NEPHRECTOMY Ithaar Derweesh*, La Jolla, CA; Reza Mehrazin, Memphis, TN; Wassim Bazzi, Ryan Kopp, Jonathan Silberstein, Sandra Belderian, Jonathan Shiau, Marianne Chenoweth, Tracy Downs, Christopher Kane, La Jolla, CA; Anthony Patterson, Jim Wan, Memphis, TN INTRODUCTION AND OBJECTIVES: Nephron Sparing Surgery (NSS) has emerged as a preferred option for the management of small renal masses, comparing favorably with radical nephrectomy (RN) from the standpoint of long-term oncologic efficacy and conferring superior renal functional preservation. Glucose metabolism may be affected by declining renal function. We examined the incidence and risk factors for development of Diabetes Mellitus (DM) in patients who underwent RN and NSS. METHODS: Multi-center retrospective review of 905 patients (610 RN/295 NSS, mean age 57.5 years, mean follow-up 5.8 years) who underwent RN or NSS for renal tumors at two institutions from 7/1987 to 6/2007. Demographics, renal function and metabolic parameters [Body mass index (BMI), Glomerular Filtration Rate (GFR), proteinuria, serum creatinine] and history of preoperative and postoperative DM were recorded. Data were analyzed within subgroups based on treatment (RN vs. NSS). Multivariate analysis (MVA) was conducted to elucidate risk factors for development of DM following surgery. RESULTS: There were no significant differences with respect to mean follow-up, age, race, sex, or BMI. Tumor size (cm) was significantly larger for RN (RN 7.0 vs. NSS 3.7, p⬍0.0001). Significantly greater proportion of NSS patients had preoperative DM (NSS 27.1% vs. RN 20.8% p⫽0.034). Postoperatively, significantly more de novo DM developed in RN vs. NSS (11.4 % vs. 3.5%, p⬍0.0001). MVA demonstrated BMI ⬎30kg/m2 (OR 21.28, p⬍0.0001), hypertension (OR 2.13, p⫽0.0261), preoperative eGFR ⬍60mL/min/1.73m2 (OR 4.55, p⫽0.0189), preoperative proteinuria (OR 6.80, p⫽0.0221), postoperative eGFR ⬍60 mL/min/1.73m2 (OR 8.82, p⬍0.0001), postoperative proteinuria (OR 6.90, p⬍0.0001) and RN (OR 2.93, p⫽0.0107) as significantly associated with DM development. CONCLUSIONS: Patients who underwent RN had significantly higher incidence of de novo DM compared to a contemporary, wellmatched cohort that underwent NSS. In addition to RN, BMI ⬎30kg/m2, hypertension, preoperative eGFR⬍60, preoperative proteinuria, postoperative eGFR⬍60, and postoperative proteinuria were also significantly associated with development of DM. Further investigation on effects of nephron loss on glucose metabolism is requisite. Source of Funding: None

Vol. 183, No. 4, Supplement, Monday, May 31, 2010

815 RENAL FUNCTIONAL OUTCOMES AFTER PARTIAL NEPHRECTOMY WITH EXTENDED ISCHEMIC INTERVALS ARE BETTER THAN AFTER RADICAL NEPHRECTOMY Brian Lane*, Grand Rapids, MI; Christopher Weight, Amr Fergany, Steven Campbell, Cleveland, OH INTRODUCTION AND OBJECTIVES: Partial nephrectomy (PN) is now a standard-of-care for clinical stage T1 renal cancers felt amenable to a nephron-sparing approach. Based on tumor size and location, some PN can be more challenging and necessitate longer ischemic intervals and RN is considered an alternative standard-ofcare for these tumors. Herein we evaluate whether PN under extended ischemia in fact provides improved renal functional outcomes compared with radical nephrectomy (RN). METHODS: Renal functional outcomes were analyzed in 2404 patients with serum creatinine (sCr) ⬍⫽ 1.4 mg/dl and two functioning kidneys who underwent partial (76%, n⫽1833) or radical (24%, n⫽571) nephrectomy for cT1 renal cancer at Cleveland Clinic. PN patients were grouped according to duration of ischemia: limited (⬍30 minutes), unknown or extended (⬎30 minutes). RESULTS: Patients in all 4 groups had similar preoperative sCr (median 0.9 mg/dl) and GFR (median 82 to 84 mL/min/1.73m2). Patients undergoing RN on average were older, had more comorbidities, and larger tumors (p⬍0.001). Regardless of type of surgery, this cohort as a whole was at low risk (⬍2%) for renal failure (GFR ⬍15 mL/min/ 1.73m2). However, patients in the RN cohort (35%) were far more likely (p⬍0.001) to have GFR ⬍45 mL/min/1.73m2 then any of the PN groups (limited: 11%, unknown: 16%, extended: 19%). CONCLUSIONS: Even when performed with extended ischemia, PN is associated with superior renal functional outcomes to RN for clinical stage T1 renal cancers. PN should be considered even for complex tumors, in which anticipated ischemia may exceed 30 minutes. Renal functional outcomes in patients with clinical stage 1 renal tumors according to type of nephrectomy and duration of ischemia Partial Nephrectomy (PN) Limited Unknown Extended (804) (546) (483)

(571)

P value

0.9 (0.8–1.1)

0.9 (0.8–1.1)

N.S.1*

84 (69–97)

84 (70–98)

83 (67–97)

N.S.1*

81 (64–96)

82 (64–96)

70 (54–87)

52 (41–63)

⬍0.0011†

Median preop sCr (IQR)

0.9 (0.8–1.1)

0.9 (0.8–1.1)

Median preop GFR (IQR)

82 (69–96)

Median postop GFR (IQR) Pct decrease in GFR

Radical Nephrectomy

0%

0%

15%

35%

⬍0.0011†

Pct with postop GFR ⬍ 45 (No.)

6.1% (49)

6.6% (36)

14% (67)

35% (202)

⬍0.0012†

Pct with postop GFR ⬍ 15 (No.)

0.0013†

0.0% (0)

0.4% (2)

0.2% (1)

1.4% (8)

Median latest GFR (IQR)

72 (56–87)

74 (56–88)

68 (51–83)

52 (41–63)

⬍0.0011†

Pct decrease in GF

12%

12%

19%

35%

⬍0.0011†

Pct with latest GFR ⬍ 45 (No.)

11% (84)

15% (79)

19% (83)

35% (202)

⬍0.0012

Pct with latest GFR ⬍ 15 (No.)

0.3% (2)

0.9% (5)

0.9% (4)

1.9% (11)

0.023

1. T-test; 2. Pearson chi-square with Yates’ continuity correction; 3. Exact Fisher test *No paired differences ⬍0.05; †RN significantly different from all PN groups (⬍0.001); extended PN significantly different from limited and unknown PN (⬍0.05); limited and unknown PN not significantly different (⬎0.05)

Source of Funding: None