Effect of obesity and overweight status on complications and survival after minimally invasive kidney surgery in patients with clinical t2 renal masses.

To evaluate the effect of obesity and overweight on surgical, functional and survival outcomes in patients with large kidney masses after minimally invasive surgery (MIS).

Within a multi-center, multi-national dataset, patients diagnosed with a ≥cT2 renal mass and treated with minimally invasive (laparoscopic or robotic) kidney surgery (radical or partial nephrectomy) during the period 2003-2017 were abstracted. They were stratified according to the body mass index (BMI) classes as normal-weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2) and obese (≥30.0 kg/m2). Mixed models and Cox proportional hazard regression tested differences in complication rates, eGFR change over time, overall mortality (OM) and disease recurrence (DR) rates.

Of 812 patients, 30.6% were normal-weight, 42.7% were overweight and 26.8% obese. Overweight (OR 0.82, 95% CI: 0.51-1.51, p=0.406) and obese patients (0.81, 95% CI: 0.44-1.47, p=0.490) experienced similar complication rates than normal weight. Moreover, no statistically significant differences in eGFR were found for overweight (p=0.129) or obese (p=0.166) patients compared to normal-weight. However, higher OM rates were recorded in overweight (HR 3.59, 95%CI: 1.03-12.51, p=0.044) as well as in obese patients (HR 7.83, 95%CI: 2.20-27.83, p=0.002). Similarly, higher DR rates were recorded in obese (HR 2.76, 95%CI: 1.40-5.44, p=0.002).

Obese and overweight patients do not experience higher complication rates or worse eGFR after minimally invasive kidney surgery, which therefore can be deemed feasible and safe also in these subset of patients. Nevertheless, obese and overweight patients seem to carry a higher risk of OM, and therefore they should undergo a strict follow-up after surgery.

Journal of endourology. 2020 Jan 17 [Epub ahead of print]

Michele Marchioni, Francesco Berardinelli, Chao Zhang, Giuseppe Simone, Robert Uzzo, Umberto Capitanio, Andrea Minervini, Clayton Lau, Jihad Kaouk, Peter Langestroer, Enrico Checcucci, Nicolò De Luyk, James Robert Porter, Michele Gallucci, Alexander Kutikov, Alessandro Larcher, Andrea Mari, Patrick Sean Kilday, Koon Ho Rha, Giuseppe Quarto, Sisto Perdona, Wesley White, Daniel Eun, Ithaar H Derweesh, Alexandre Mottrie, Uzoma Arnold Anele, Kenneth M Jacobsohn, Francesco Porpiglia, Benjamin Challacombe, Chandru P Sundaram, Riccardo Autorino, Bo Yang, Luigi Schips

Universita degli Studi Gabriele d'Annunzio Chieti e Pescara, 9301, Urology, Via Dei Vestini, Chieti Scalo, Italy, 66013; ., ASL 2 Abruzzo, 220464, Chieti, Abruzzo, Italy; ., Shangchai, China; ., Regina Elena, urology, via elio chianesi 53, Roma, Italy, 00144., Fox Chase Cancer Center, 6565, 333 Cottman Ave, Philadelphia, Pennsylvania, United States, 19111; ., Milan, Italy; ., Department of Urology, University of Florence, Careggi Hospital, Florence, Italy., Urology, Clinica Urologica I, Azienda Ospedaliera Careggi, Università di Firenze., Largo Brambilla 3 - San Luca Nuovo Padiglione 16/Settore C/Piano II, Florence, Italy, 50134; ., City of Hope, Urology, Duarte, California, United States; ., Cleveland Clinic Foundation, Glickman Urologic Institute, 9500 Euclid Ave, Cleveland, Ohio, United States, 44195; ., Milwaukee, United States; ., Azienda Ospedaliero Universitaria San Luigi Gonzaga, 9340, Urology, Orbassano, Italy; ., Urology Clinic, Urology, Verona, Italy; ., Swedish Medical Center, Urology, 1101 Madison, Suite 1400, Seattle, Washington, United States, 98104; ., "Regina Elena" National Cancer Institute, Roma, Italy; ., Children's Hospital of Philadelphia, Urology, 3400 Civic Center Blvd, Philadelphia, Pennsylvania, United States, 19102; ., IRCSS San Raffaele Hospital, URI - Urological Research Institute, Via Olgettina 60, Milano, Milan, Italy, 20127., Department of Urology, University of Florence, Careggi Hospital, Florence, Italy., Urology, Florence, Italy; ., Kaiser Permanente, Department of Urology, 4900 Sunset Blvd, Second Floor Department of Urology, LOS ANGELES, California, United States, 90027; ., Severance Hospital, Yonsei University, Urology, Yonseiro 50-1, Seodaemun-gu, Seoul, Korea, Seoul, Korea (the Republic of); ., Naples, Italy; ., INT Pascale Foundation, Urology, Napoli, Italy; ., University of Tennessee Medical Center-Knoxville, Urology, Knoxville, Tennessee, United States; ., Temple University, Urology, 255 South 17th street, 7th Floor Urology Suite, Philadelphia, Pennsylvania, United States, 19103; ., University of California - San Diego, Urology, La Jolla, California, United States; ., Onze Lieve Vrouwziekenhuis, 37467, Dep. of Urology, Aalst, Belgium, 9300; ., Virginia Commonwealth University Health System, 6887, Urology, Division of Urology, VCU Medical Center, Box 980118, Richmond, Virginia, United States, 23298-0118; ., Medical College of Wisconsin, Department of Urology, 10527 river lake dr, Mequon, Wisconsin, United States, 53092; ., San Luigi Hospital, Urology, Regione Gonzole 10, Orbassano, Italy, 10043; ., Guy's Hospital, Urology, London, London, United Kingdom of Great Britain and Northern Ireland, SE1 7RT; ., Indiana University School of Medicine, Urology, 535 N Barnhill Dr, Suite 420, Indianapolis, Indiana, United States, 46202; ., Virginia Commonwealth University Health System, 6887, Surgery (Urology), 1200 East Broad st, Richmond, Virginia, United States, 23298; ., Shanghai Changhai Hospital, Department of Urology, 168 Changhai Road, shanghai, shanghai, China, 200433; ., Universita degli Studi Gabriele d'Annunzio Chieti e Pescara, 9301, Urology, Chieti Scalo, Italy; .