title: Nephron-sparing techniques independently decrease the risk of cardiovascular events relative to radical nephrectomy in patients with a T1a-T1b renal mass and normal preoperative renal function.
abstract: BACKGROUND
  Some reports have suggested that nephron-sparing surgery (NSS) may protect against cardiovascular events (CVe) when compared with radical nephrectomy (RN). However, previous studies did not adjust the results for potential selection bias secondary to baseline cardiovascular risk.
  
  
  OBJECTIVE
  To test the effect of treatment type (NSS vs RN) on the risk of developing CVe after accounting for individual cardiovascular risk.
  
  
  METHODS
  A multi-institutional collaboration including 1331 patients with a clinical T1a-T1b N0 M0 renal mass and normal renal function before surgery (defined as an estimated glomerular filtration rate≥60 ml/min/1.73 m2).
  
  
  METHODS
  RN (n=462, 34.7%) or NSS (n=869, 65.3%) between 1987 and 2013.
  CVe was defined as onset during the follow-up period of coronary artery disease, cardiomyopathy, hypertension, vasculopathy, heart failure, dysrhythmias, or cerebrovascular disease not known before surgery. Cox regression analyses were performed. To adjust for inherent baseline differences among patients, we performed multivariate analyses adjusting for all available characteristics depicting the overall and cardiovascular-specific profile of the patients.
  
  
  CONCLUSIONS
  When stratifying for treatment type, the proportion of patients who experienced CVe at 1, 5, and 10 yr was 5.5%, 9.9%, and 20.2% for NSS patients compared to 8.7%, 15.6%, and 25.9%, respectively, for RN patients (p=0.001). In multivariate analyses, patients who underwent NSS showed a significantly lower risk of developing CVe compared with their RN counterparts (hazard ratio 0.57, 95% confidence interval 0.34-0.96; p=0.03) after accounting for clinical characteristics and cardiovascular profile. Limitations include the retrospective design of the study because other potential confounders may exist.
  
  
  CONCLUSIONS
  The risk of CVe after renal surgery is not negligible. Patients treated with NSS have roughly half the risk of developing CVe relative to their RN counterparts. After accounting for clinical characteristics, comorbidities, and cardiovascular risk at diagnosis, NSS independently decreases the risk of CVe relative to RN.
  
  
  RESULTS
  The risk of having a cardiovascular event after renal surgery decreases if a portion of the affected kidney is spared.
authors.affiliation: Department of Urology, San Raffaele Scientific Institute, Milan, Italy; Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy. Electronic address: umbertocapitanio@gmail.com.
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.affiliation: Department of Urology, University of Piemonte Orientale, Novara, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Terrone
authors.affiliation: Department of Urology, Università degli studi e Spedali Civili di Brescia, Brescia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Antonelli
authors.affiliation: Department of Urology, Clinica Urologica I, Azienda Ospedaliera Universitaria Careggi, Università degli studi di Firenze, Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Minervini
authors.affiliation: Department of Urology, University of Piemonte Orientale, Novara, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Volpe
authors.affiliation: Department of Urology, Università degli studi e Spedali Civili di Brescia, Brescia, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Furlan
authors.affiliation: Department of Urology, San Raffaele Scientific Institute, Milan, Italy; Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Rayan
authors.initials: R
authors.lastname: Matloob
authors.affiliation: Department of Urology, University of Piemonte Orientale, Novara, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Regis
authors.affiliation: Department of Urology, AOU San Luigi Gonzaga, Università degli studi di Torino, Orbassano, Italy.
authors.forename: Cristian
authors.initials: C
authors.lastname: Fiori
authors.affiliation: Department of Urology, AOU San Luigi Gonzaga, Università degli studi di Torino, Orbassano, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Porpiglia
authors.affiliation: Department of Urology, San Raffaele Scientific Institute, Milan, Italy; Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Ettore
authors.initials: E
authors.lastname: Di Trapani
authors.affiliation: Department of Urology, University of Piemonte Orientale, Novara, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Zacchero
authors.affiliation: Department of Urology, Clinica Urologica I, Azienda Ospedaliera Universitaria Careggi, Università degli studi di Firenze, Florence, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Serni
authors.affiliation: Department of Urology, San Raffaele Scientific Institute, Milan, Italy; Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Salonia
authors.affiliation: Department of Urology, Clinica Urologica I, Azienda Ospedaliera Universitaria Careggi, Università degli studi di Firenze, Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Carini
authors.affiliation: Department of Urology, Università degli studi e Spedali Civili di Brescia, Brescia, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Simeone
authors.affiliation: Department of Urology, San Raffaele Scientific Institute, Milan, Italy; Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: Department of Urology, San Raffaele Scientific Institute, Milan, Italy; Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bertini
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods*; D009399:Nephrons / Q000503:physiopathology* / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D012307:Risk Factors
keywords: Cardiovascular event; Kidney cancer; Nephron-sparing surgery; Overall survival; Partial nephrectomy; Radical nephrectomy