An one-year prospective study of the serial psychological behavior
accompanied with renal function loss after
radical nephrectomy or nephron-sparing surgery
Yun-Chu Chang1、Tzu-Ping Lin1,3,4、Wen-Chin Chiu1、Feng-Chu Huang1、Yen-Hwa Chang1,3,4
Hsiao-Jen Chung1,3,4、Eric YH Huang1,3,4、Chi-Chieh Lin1,3,4、I-shen Huang1,3,4
Yuan-Hwa Chou2、William J.S. Huang1,3,4、Alex T.L. Lin1,3,4
1 Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan,
2Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan,
3 School of Medicine, National Yang-Ming University, Taipei, Taiwan;
4Shu-Tien Urological Research Center, Taipei, Taiwan
一年期前瞻性研究: 根除性腎臟切除或部分腎臟切除手術後
國立陽明大學 醫學院 泌尿學科3 ; 書田泌尿科學研究中心
Quality of life(QOL) has became a major concern because many reports suggest an comparable oncological outcome between the nephron-sparing surgery ( NSS ) and radical nephrectomy ( RN ). However, there lacks literature studying the serial psychological behavior correlated with renal function loss.
Materials and methods:
We prospectively recruited newly diagnosed renal tumor and upper tract urothelial carcinoma patients who received curative operation ( NSS or RN for renal tumor and radical nephroureterectomy with bladder cuff excision for UTUC) between November 2014 and March 2017. All patients completed pre-operative, post-operative 3 month, post-operative 6 month and post-operative 12 month questionnaires including Beck Anxiety Inventory, Beck Depression Inventory-II and EORTC QLQ-C30 (version 3) Chinese version and blood test for eGFR level.
A total of 108 patients were enrolled with 17% drop out rate. 64 renal tumor and 37 upper tract urothelial carcinoma patients were recruited. 50 patients received NSS and 51 patients received RN. 54 patients were male( 53.5% ). The mean age at surgery was 61.3 ± 16.6 years and average BMI was 24.9 ± 5.3 kg/m2. The eGFR level were poorer in RN and UTUC group pre-operatively. These discrepancies persisted in the post-op 3month to 12 month follow-up. Besides, only the NSS group showed no renal function deterioration post-operatively. In NSS, RN and renal tumor groups, general psychological improvements after the operation were found while UTUC group showed poorer post-operative 3 month physical function, severer dyspnea, insomnia, constipation, and diarrhea. In RN group, The depressive mood was more evident than NSS group after operation till post-op 12 months, and showed persistent severer fatigue and dyspnea symptom. Poorer depressive mood, global health, function domains and symptom domains were noted at the post-op 3 months UTUC group compared with renal tumor group. The total eGFR level was correlated with function domains in serial follow-up, but this correlation was not seen in each tumor type or nephrectomy method. In subgroup analysis, patients with poor pre-op eGFR level ( <60 mL/min/1.73m2) showed no difference in psychological behavior with intact pre-op eGFR level.
    This is the first prospective study examing the correlation between the serial psychological behavior and the renal function loss after radical nephrectomy or nephron-sparing surgery. Depressive mood, fatigue and dyspnea were severer in RN group from pre-op stage to post-op 12 months, but the difference could not be explained by the evident renal function loss in RN group.
    2019-01-07 13:41:20
    2019-01-07 13:52:24
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