1435 IMPACT OF ISCHEMIA TIME AND MODALITY ON RENAL FUNCTIONAL OUTCOME AFTER OPEN PARTIAL NEPHRECTOMY

Objective: To evaluate the association between renal tumour scoring systems and open partial nephrectomy ischemia time.Methods: A historical cohort of open partial nephrectomy patients at The Ottawa Hospital between 2002 and 2009 was reviewed. Preoperative patient characteristics (age, gender, preoperative renal function, diabetes, hypertension, smoking history, heart disease) and ischemia time were abstracted from medical records. Preoperative computed tomography (CT) images were reviewed and tumours were characterized using three scoring systems: (1) R.E.N.A.L. nephrometry score (radius, exophytic/endophytic properties, nearness of tumour to the collecting system or sinus in millimetres, anterior/posterior, location relative to polar lines); (2) preoperative aspects and dimensions used for anatomic (PADUA) classification; and (3) Centrality index (C index). Patients without preoperative CT and patients treated with laparoscopic partial nephrectomy were excluded.Results: During the study period, 78 patients met the inclusion criteria. Median R.E.N.A.L. score was 7 (interquartile range [IQR] 5-8), median PADUA score was 8 (IQR 7-10), and mean C index was 3.9 (standard deviation [SD] 2.1). Mean ischemia time was 23.4 (SD 10.8) minutes. Five individual tumour characteristics (diameter, nearness to collecting system, anterior/posterior location, medial/lateral location, and collecting system involvement) were strongly associated with ischemia time (p < 0.05). Increased R.E.N.A.L. score (1.5 minutes per unit 95%CI 0.08, 2.9, p = 0.04) and PADUA score (2.0 minutes per unit 95%CI 0.5, 3.5, p = 0.009) were significantly associated with ischemia time. An increasing C index score was also associated with ischemia time (-1.1 minutes per unit 95%CI -2.2, 0.04, p = 0.06), but the association was not statistically significant.Conclusion: Renal tumour characteristics are associated with ischemia time. The proposed scoring systems are useful descriptors of surgical complexity and should be used when describing partial nephrectomy patients. Prospective evaluation and refinement of scoring systems are required to create an optimized model prior to widespread application.

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Comparison of Laparoscopic and Open Partial Nephrectomy in the Treatment of T1 Renal Tumor:a Systematic Review and Meta-analysis

10.21203/rs.3.rs-48507/v1 ◽

2020 ◽

Author(s):

Yuanming Sui ◽

Zongliang Zhang ◽

Huaqing Sun ◽

Kai Zhao ◽

Zhenlin Wang ◽

...

Keyword(s):

Postoperative Complications ◽

Partial Nephrectomy ◽

Meta Analysis ◽

Positive Margin ◽

Current Evidence ◽

Surgical Approaches ◽

Open Partial Nephrectomy ◽

Ischemia Time ◽

Standard Mean Difference ◽

Estimated Blood Loss

Abstract Objective:Different surgical approaches may bring different treatment results for one disease.We thus determined to gather the current evidence to evaluate the effect of laparoscopic partial nephrecomy(LPN) and open partial nephrectomy(OPN) in the treatment of T1 renal tumor.Methods:We comprehensively researched PubMed,Embase,Google Scholar and Clinicaltrials.gov to find all referring studies(published between Jan1,2015,and Jan 1,2020 without language restrictions) .We calculated the odds ratios(OR) and standard mean difference(SMD),and analyzed their heterogeneity with RevMan 5.3 software.Results:Six studies were included finally.Comparing open partial nephrectomy, the pooled SMD of operative time was 0.14, (95% confidential index CI = [-0.11, 0.38]), the pooled SMD of estimated blood loss was -0.14, (95% CI = [-0.58, 0.31]), the pooled SMD of ischemia time was 0.57, (95% CI = [-0.02, 1.16]), the pooled SMD of length of stay was -0.55, (95% CI = [-1.12, 0.02]),and the pooled OR of positive margin was 1.02, (95% CI = [0.39, 2.68]),the pooled OR of postoperative complications was 0.74,(95% CI = [0.41, 1.36]). Conclusions:LRN had advantages on decreasing postoperative complications rate but the ischemia time of OPN was much shorter.

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Open partial nephrectomy with modified technique: Comparison to results from contemporary laparoscopic series.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.7_suppl.473 ◽

2015 ◽

Vol 33 (7_suppl) ◽

pp. 473-473

Author(s):

Thomas Alexander Voegeli ◽

Richard Demming

Keyword(s):

Partial Nephrectomy ◽

Argon Plasma Coagulation ◽

Oncological Outcome ◽

Warm Ischemia ◽

Modified Technique ◽

Cancer Specific Survival ◽

Open Partial Nephrectomy ◽

Ischemia Time ◽

Hemostatic Agents ◽

The Mean

473 Background: To evaluate the surgical and oncological outcome of patients undergoing a modified procedure of open partial nephrectomy which was done with a new technique leaving out selective suturation of renal calices and vessels. Methods: We analyzed 120 consecutive open partial nephrectomies (2005-2010) which were performed with a modified technique at a mid-volume center. This technique included the use of an absorbable non-woven textile consisting of polyglycolic acid, extra-large needles and argon plasma coagulation. The surgical and oncological outcome was evaluated by statistical analysis of the medical records. Results: The mean patient age was 62.8 years (52.6% male). Mean pathological tumor size was 3.0 cm (± 1.4 cm), 53.3% of the tumors were renal cell carcinoma. The mean operative time was 101.7 minutes (±33.6 min) and the mean blood loss was 283.9 ml (±368.5 ml). Ischemia was performed in 23.1% with a mean warm ischemia time of 13.3 minutes ( ± 6.4 min). The operative complication rate was 1.7 %. Topical hemostatic agents were used in 20.2 %. The most frequent postoperative complications were bleeding (5%), pleural effusion (4.2%), urinoma (2.5%), pneumonia (2.5%), wound infection (2.5%) and acute renal failure (2.5%). Five-year cancer specific survival rate was 94.1%. Conclusions: The modified technique of open partial nephrectomy can be performed with high surgical and oncologic safety. Duration of the procedure and ischemia time are short. Due to the rare use of hemostatic agents, the costs can be reduced. Open partial nephrectomy with this technique achieve better results than reported from contemporary reported laparoscopic series, especially regarding warm ischemia and time needed for surgery.

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