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INTRODUCTION AND OBJECTIVES:Partial nephrectomy (PN) represents the current surgical standard for T1 tumors. With the wider application of nephron-sparing surgery, potentially life-threatening post...

Preoperatively predicting postoperative kidney function is an essential step to achieve improved renal function and prevent chronic kidney disease. We introduce a novel formula especially to calculate resected and ischemic volume before partial nephrectomy. We examined whether resected and ischemic volume would have value for predicting postoperative renal function.We performed a retrospective cohort study in 210 patients who underwent robotic partial nephrectomy between September 2006 and October 2013 at a tertiary cancer care center. Based on abdominopelvic computerized tomography and magnetic resonance imaging we calculated resected and ischemic volume by the novel mathematical formula using integral calculus. We comparatively analyzed resected and ischemic volume, and current nephrometry systems to determine the degree of association and predictability regarding the severity of the postoperative functional reduction.On multivariable analysis resected and ischemic volume showed a superior association with the absolute change in estimated glomerular filtration rate/percent change in estimated glomerular filtration rate (B = 6.5, p = 0.005/B = 6.35, p = 0.009). The ROC AUC revealed accurate predictability of resected and ischemic volume on the stratified event of an absolute change in estimated glomerular filtration rate/event of percent change in estimated glomerular filtration rate compared to 3 representative nephrometry systems. The calibration plot of this model was excellent (close to the 45-degree line) within the whole range of predicted probabilities.We report a method of preoperatively calculating resected and ischemic volume with a novel formula. This method has superior correlation with the absolute and percent change in estimated glomerular filtration rate compared to current nephrometry systems. The predictive model achieved a strong correlation for the absolute and percent change in estimated glomerular filtration rate.

INTRODUCTION AND OBJECTIVES: Renal Cell Carcinoma (RCC) incidence is increasing and there is little data on causative or preventative pharmacological agents. To date, some data suggests that statins may reduce RCC risk and nonsteroidal anti-inflammatory drugs (NSAIDs) may increase RCC risk but these data are primarily retrospective. In this study, we examine the relationship between use of statins and NSAIDs on the risk of RCC using a contemporary, population-based prospective cohort. METHODS: Participants in the VITAL Study – (VITamins and Lifestyle) aged 50-76 years comprised the study population. Participants enrolled and completed questionnaires in 2000-2002 on cancer risk factors including medication usage. Incident cases of RCC were identified via linkage to the cancer registry. For NSAID use, ten-year use of aspirin and other NSAIDs was categorized as none, low-use (1-3 days/week or 4 years), or high-use ( 4 days/week and 4 years). Participants were queried on the use of statins in the last 2 weeks. Cox regression analyses estimated the hazard ratios (HR) for RCC in both a base (age and gender adjusted) and multivariate model (base race, smoking, alcohol use, BMI, kidney disease, hypertension, diabetes, viral hepatitis). RESULTS: A total of 249 cases of RCC were detected. Statin use was reported by 20% of participants. In the base model, statin use was associated with an increased risk of RCC (HR 1.4, 95%CI 1.0-1.8) yet failed to maintain significance in the multivariate model (HR 1.1, 0.8-1.4). A similar relationship was found for NSAID use. Compared to non-users, low (HR 1.2, 0.8-1.6) and high (HR 1.4, 1.0–2.0) users of NSAIDs (aspirin and non-aspirin NSAIDs) had an increased risk of RCC in the base model (p-trend 0.03). However, this relationship was attenuated and non-significant (p-trend 0.35) in the multivariate model for both low (HR 1.01, 0.7-1.4) and high (1.2, 0.8-1.7) users compared to non-users. CONCLUSIONS: The results of this study do not support previous findings that statin and NSAID use are associated with the risk of RCC. The observed relationships between these commonly used medications and RCC risk do not persist after adjusting for known risk factors for RCC.