Anterior Approach Laparoscopy Kidney Tumor Surgery Associates With Chronic Kidney Diseases After Surgery

Background Renal cell carcinoma is a malignant tumor originating from the renal tubular epithelial system,also known as renal adenocarcinoma,which accounts for 80%to 90%of kidney-derived malignancies.Renal cell carcinoma accounts for about 2%to 3%of adult malignancies,with a high incidence of 50-70 years.In 2010,AJCC confirmed the TNM staging of renal cell carcinoma.Among them,localized renal cell carcinoma was considered to have TNM stage T1～2N0M0 and clinical stage Ⅰ and Ⅱ stage.At present,surgery is the first choice for localized renal cell carcinoma.The surgical plan is basically divided into two types.One is radical nephrectomy.The scope of resection includes perirenal fascia,perirenal fat,kidney,and the ureter above the bifurcation of the iliac artery;the second is to preserve the nephron surgery,the scope of resection includes the tumor,the pseudo-envelope and some surrounding normal kidney tissue.Under normal circumstances,the kidney has a strong compensatory function,and the internal environment is stable when the loss of renal function is less than 75%.However,patients with renal cell carcinoma,especially those with localized renal cell carcinoma,undergo renal surgery and intraoperative normal renal tissue resection,physical injury,preservation of warm ischemia injury in nephron surgery,perioperative complications,and the underlying diseases such as hypertension in the patient itself may cause a large number of nephrons to be continuously destroyed.And after the nephron is reduced,the preserved kdney unit compensatory hypertrophy,glomerular filtration rate of single nephron increases,forming glomerular hyperperfusion,high pressure and high filtration,this hemodynamic change can further damage the nephron,leading to the postoperative incidence of chronic kidney disease is much higher than the normal population.Objective:In the case of ensuring complete resection of the tumor,how to minimize the loss of renal function and reduce the incidence of chronic kidney disease remains to be further explored.This study mainly conducted a retrospective analysis of the clinical data of patients with renal tumor surgery by Prof.Xu Zhonghua team from Qilu Hospital of Shandong University from January 2016 to December 2016 to srudy the relationship between anterior approach laparoscopy kidney tumor surgery and chronic kidney diseases after surgery.Methods:A retrospective analysis of 138 patients who underwent surgical treatment at the Qilu Hospital of Shandong University from January 2016 to December 2016 with surgical treatment as the initial treatment and postoperative pathology and confirmed renal cell carcinoma to analyze the relationship between clinical features of patients undergoing renal tumor surgery and postoperative chronic kidney disease.Result:The preoperative GFR values of the no chronic kidney disease group,the chronic kidney disease caused by surgery group and the already having chronic kidney disease group were 54 ml/(min*1.73m2),69 ml/(min*1.73m2)and 79 ml/(min*1.73m2),respectively.The eGFR values 2 months after surgery of these three groups were 47 ml/(min*1.73m2),53 ml/(min*1.73m2)and 72 ml/(min*1.73m2).The-eGFR values 2 years after surgery of these three groups were 39 ml/(min*1.73m2),47 ml/(min*1.73m2)and 68 ml/(min*1.73m2),respectively.After calculating the GFR loss in 2 years after surgery and 2 months after surgery,it was found that the amount of GFR loss in the already having chronic kidney disease group and chronic kidney disease caused by surgery group was higher than that in the no chronic kidney disease group.GFR loss was higher in patients with hypertension than in non-hypertensive group;GFR loss was higher in patients with diabetes than in non-diabetic group;GFR loss was higher in patients with coronary heart disease than in non-coronary heart disease group;the GFR loss was higher in patients with perioperative complications.than in non-perioperative complications group.In the study of nephron sparing surgery,the difference between the GFR value before surgery and the GFR value after 2 months was used as the observation index-the amount of GFR loss during the operation,and it was found that the warm ischemia time had a significant effect on the amount of GFR loss during the operation.Conclusion:For patients undergoing surgical treatment of renal tumors,the total level of residual renal function after surgery has an important impact on the incidence of chronic kidney disease in long-term observation.Hypertension,diabetes,coronary heart disease and other perioperative complications are also important influencing factors.