Tumor location does not impact return of renal function following partial nephrectomy

14511 Background: To study the impact of tumor location on the glomerular filtration rate (GFR) changes following partial nephrectomy. Methods: We reviewed our institutional database to identify patients who underwent partial nephrectomy between 1/1995 and 7/2005. Preoperative CT and/or MRI studies were reviewed to characterize tumors as either central or peripheral. Central tumors were defined as those involving the collecting system or renal sinus; all others were categorized as peripheral. We used the Abbreviated Modification of Diet in Renal Disease study equation to estimate GFR preoperatively, in the early postoperative hospital stay, and at 1 and 12 months after surgery. Multivariate models were fit to determine the association of tumor location with changes in GFR at each time period after controlling for age, sex, tumor size, American Society of Anesthesia Score, ischemic time, operative time, and blood loss. Results: A total of 616 patients (265 central and 351 peripheral tumors) were available for analysis. Patients with central tumors were younger compared to those with peripheral tumors (62 vs. 59, p = 0.014), had longer intraoperative renal ischemia (40 vs. 30 min, respectively, p < 0.001), and had longer operations (201 vs. 184 min, respectively, p = 0.01). Although baseline GFR did not differ between the groups, a significantly larger decrease in GFR was found in patients with central compared to peripheral tumors in the early postoperative period (−16 vs. −11 cc/min/1.73 m2, p = 0.013) and 1-month follow-up (−10 vs. −6 cc/min/1.73 m2, p = 0.017). The GFR change was similar at 1-year follow-up, −10 and −11 cc/min/1.73m2 (p = 0.586) for central and peripheral tumors, respectively. On multivariate analysis, tumor location was not significantly associated with the change in GFR at any of the time intervals after adjusting for size, ischemic time, operative time, age, sex and comorbidity. Conclusions: Patients with centrally located tumors have a more pronounced short-term decrease in GFR, which reflects a longer operative time and ischemia duration. Tumor location does not appear to impact the long-term renal function. This suggests that renal sparing surgery should not be withheld from this subset of patients. No significant financial relationships to disclose.

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Early clamp release during laparoscopic partial nephrectomy: Implications for preservation of renal function

Canadian Urological Association Journal ◽

10.5489/cuaj.4166 ◽

2017 ◽

Vol 11 (7) ◽

pp. E261-5 ◽

Cited By ~ 2

Author(s):

Jeffrey Campbell ◽

Garson Chan ◽

Patrick P. Luke

Keyword(s):

Renal Function ◽

Renal Dysfunction ◽

Partial Nephrectomy ◽

Tumour Size ◽

Standard Technique ◽

Bleeding Risk ◽

Early Postoperative Period ◽

Control Group ◽

Ischemic Time ◽

Significant Difference

Introduction: Intraoperative warm ischemic time (WIT), associated with hilar clamping during partial nephrectomy (PN), is an established modifiable risk factor for renal dysfunction. We assessed early clamp release (ECR) as a strategy to reduce WIT and assess its impact on renal function and bleeding.Methods: We retrospectively assessed patients who underwent minimally invasive PN by a single surgeon at our centre since December 2011. Comparing the standard technique to an ECR modification, WIT, complications, change in estimated glomerular filtration rate (eGFR), and change in differential function as demonstrated by MAG-3 nuclear renography were assessed. Followup blood work and renograms were performed at 6‒12 weeks postoperatively and compared to baseline in 70 patients (35 ECR: 35 control).Results: The ECR and control groups were similar in age, sex, and tumour size, with only patient weight being higher in the ECR group (91.6 vs. 81.6 kg; p<0.05). WIT was significantly lower in ECR group compared to control (18.8 vs. 31.5 minutes; p<0.05). Although there was no significant difference in change from baseline eGFR in the early postoperative period (Day 3) or in followup (6‒12 weeks), the control group had a significantly greater loss of ipsilateral renal function from baseline compared to the ECR group (9 vs. 4% change; p<0.05). Blood loss and complication rate weresimilar between groups.Conclusions: The ECR technique offers a safe, reproducible alternative that reduces WIT during laparoscopic PN. ECR demonstrates a reduction in overall ipsilateral renal dysfunction, without increasingcomplication or intraoperative bleeding risk.

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Warm ischemic time’ and renal function preservation in robotic partial nephrectomy -evaluating its real impact

Urology & Nephrology Open Access Journal ◽

10.15406/unoaj.2020.08.00298 ◽

2020 ◽

Vol 8 (6) ◽

pp. 161-166

Author(s):

Krishnendu Biswas ◽

Rohan S Batra ◽

Abhishek G Singh ◽

Arvind P Ganpule ◽

Ravindra B Sabnis ◽

...

Keyword(s):

Renal Function ◽

Partial Nephrectomy ◽

Tumour Size ◽

Robotic Partial Nephrectomy ◽

Ischemic Time ◽

Warm Ischemic Time ◽

Nephrometry Score ◽

Significant Difference ◽

One Year

Objective: To evaluate the effect of warm ischemic time (WIT) on future renal function (RF) after robotic partial nephrectomy (RPN) and secondarily, also to find out predictors of future RF after RPN. Method and materials: All patients who underwent RPN with normal pre-operative RF and normal contralateral kidney were included in the study except for those in whom one-year follow up was not completed. Patients were divided in four groups based on WIT (zero, <20minutes, 20 minutes to 30 minutes and >30 minutes). Comparison of demographic and perioperative parameters including follow-up up to one year were done. Univariable and multivariable analysis were done to detect significant correlation of RF with those parameters. Results: Total 198 RPN patients were included in the study. The four groups had comparable demographic data (age, gender, comorbidity, smoking, body mass index, pre-operative RF). Progressively increased WIT was significantly associated with increased tumour size (p=0.022), RENAL nephrometry score (p=0.003), operative time (p=0.004) and blood loss (p=0.046). Post-operatively, RF on first post-operative day (p=0.627), at one month (p=0.581) and at one year (p=0.378) had no significant difference between the four groups. Nine (4.5%) patients progressed to chronic renal disease. Pre-operative RF and perioperative complications only had significant correlation with one-year RF. Conclusion: Tumour size and RENAL nephrometry score significantly influenced WIT. Pre-operative RF and peri-operative complications were the only significant predictors of future RF and not the WIT.

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875: The Effect of Warm Ischemic Time on the Ipsilateral Renal Function after Laparoscopic Partial Nephrectomy

The Journal of Urology ◽

10.1016/s0022-5347(18)33111-2 ◽

2006 ◽

Vol 175 (4S) ◽

pp. 282-283

Author(s):

Shigeta Masanobu ◽

Koji Mita ◽

Tsuguru Usui ◽

Kazushi Marukawa ◽

Toshihiro Tachikake

Keyword(s):

Renal Function ◽

Partial Nephrectomy ◽

Laparoscopic Partial Nephrectomy ◽

Ischemic Time ◽

Warm Ischemic Time

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Is whenever feasible-strategy for partial nephrectomy invariably justified? The impact of clinical tumour size on postoperative renal function

European Urology ◽

10.1016/s0302-2838(21)00950-7 ◽

2021 ◽

Vol 79 ◽

pp. S777-S778

Author(s):

G. Colandrea ◽

D. Cignoli ◽

G. Basile ◽

G. Rosiello ◽

G. Fallara ◽

...

Keyword(s):

Renal Function ◽

Partial Nephrectomy ◽

Tumour Size ◽

Postoperative Renal Function ◽

The Impact

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MP31-19 LONG-TERM FOLLOW-UP OF RENAL FUNCTION AND DEVELOPMENT OF CHRONIC KIDNEY DISEASE AFTER PARTIAL NEPHRECTOMY

The Journal of Urology ◽

10.1097/01.ju.0000557568.28232.a8 ◽

2019 ◽

Vol 201 (Supplement 4) ◽

Author(s):

Takashi Ikeda* ◽

Toshio Takagi ◽

Hiroki Ishihara ◽

Hironori Fukuda ◽

Kazuhiko Yoshida ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Renal Function ◽

Kidney Disease ◽

Partial Nephrectomy ◽

Long Term Follow Up

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The impact of gender difference on operative time in laparoscopic partial nephrectomy for T1 renal tumor and the utility of retroperitoneal fat thickness as a predictor of operative time

BMC Cancer ◽

10.1186/s12885-016-2979-5 ◽

2016 ◽

Vol 16 (1) ◽

Cited By ~ 5

Author(s):

Hiroki Ito ◽

Kazuhide Makiyama ◽

Takashi Kawahara ◽

Kimito Osaka ◽

Koji Izumi ◽

...

Keyword(s):

Gender Difference ◽

Partial Nephrectomy ◽

Operative Time ◽

Renal Tumor ◽

Laparoscopic Partial Nephrectomy ◽

Fat Thickness ◽

The Impact

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Impact of obesity on male urethral sling outcomes

Therapeutic Advances in Urology ◽

10.1177/1756287220927997 ◽

2020 ◽

Vol 12 ◽

pp. 175628722092799

Author(s):

M. Francesca Monn ◽

Hannah V. Jarvis ◽

Thomas A. Gardner ◽

Matthew J. Mellon

Keyword(s):

Operative Time ◽

Cohort Analysis ◽

Obese Patients ◽

Retrospective Cohort Analysis ◽

Surgical Complexity ◽

History Of ◽

Sling Placement ◽

The Impact ◽

Male Urethral Sling

Background: The impact of obesity on AdVance male urethral sling outcomes has been poorly evaluated. Anecdotally, male urethral sling placement can be more challenging due to body habitus in obese patients. The objective of this study was to evaluate the impact of obesity on surgical complexity using operative time as a surrogate and secondarily to evaluate the impact on postoperative pad use. Methods: A retrospective cohort analysis was performed using all men who underwent AdVance male urethral sling placement at a single institution between 2013 and 2019. Descriptive statistics comparing obese and non-obese patients were performed. Results: A total of 62 patients were identified with median (IQR) follow up of 14 (4–33) months. Of these, 40 were non-obese and 22 (35.5%) were obese. When excluding patients who underwent concurrent surgery, the mean operative times for the non-obese versus obese cohorts were 61.8 min versus 73.7 min ( p = 0.020). No Clavien 3–5 grade complications were noted. At follow up, 47.5% of the non-obese cohort and 63.6% of the obese cohort reported using one or more pads daily ( p = 0.290). Four of the five patients with a history of radiation were among the patients wearing pads following male urethral sling placement. Conclusion: Obese men undergoing AdVance male urethral sling placement required increased operative time, potentially related to operative complexity, and a higher proportion of obese compared with non-obese patients required postoperative pads for continued urinary incontinence. Further research is required to better delineate the full impact of obesity on male urethral sling outcomes.

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Sutureless laparoscopic partial nephrectomy using fibrin gel reduces ischemia time while preserving renal function

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2019.1.30 ◽

2019 ◽

Vol 91 (1) ◽

pp. 30-34 ◽

Cited By ~ 2

Author(s):

Daniele Tiscione ◽

Tommaso Cai ◽

Lorenzo Giuseppe Luciani ◽

Marco Puglisi ◽

Daniele Mattevi ◽

...

Keyword(s):

Renal Function ◽

Partial Nephrectomy ◽

Kidney Function ◽

Charlson Comorbidity Index ◽

Operative Time ◽

Warm Ischemia ◽

Control Group ◽

Fibrin Gel ◽

Ischemia Time ◽

Comorbidity Index

Objectives: We evaluated the efficacy of sutureless laparoscopic partial nephrectomy (LPN), using a fibrin gel in order to minimize renal ischemia time and preserve kidney function. Materials and Methods: Nineteen patients (mean age 58.3 ± 7.1) undergoing sutureless LPN using a fbrin gel were compared with a control group consisting of 21 patients (mean age 57.9 ± 7.5) subjected to LPN with standard suturing. Intraand post-operative data for the two groups were compared. The following parameters were recorded: patient demographics, Charlson Comorbidity Index, tumor characteristics according to the RENAL score, warm ischemia and operative times, estimated blood loss, mean hospital stay, post-operative complications referring to the Clavien-Dindo classification, renal function parameters pathologic and follow-up data. The main outcome measure was renal ischemia time and maintenance of kidney function. Results: Median warm ischemia time was 13 minutes (range 11-19) in the group treated with fibrin gel and 19 (range 17- 29) in the control group, with a statistically significant difference (p < 0.001). The two groups were homogeneous in terms of the Charlson Comorbidity Index (4.6 vs 4.8) and RENAL score (9.6 vs 9.4). Median operative time differed significantly in the two groups, 183 minutes (range 145-218) in the group treated with fibrin gel and 201 (range 197-231) in the control group (p < 0.001). A negative surgical margin was reported in 18 patients (94.7%) in the group treated with fibrin gel and in 21 patients (100%) in the control group. No difference in renal function was found between the two groups. Conclusions: Sutureless LPN with fibrin gel can reduce warm ischemia and total operative time while preserving kidney function.

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Retroperitoneal hand-assisted laparoscopic nephrectomy and partial nephrectomy

Surgical Techniques Development ◽

10.4081/std.2013.e3 ◽

2013 ◽

Vol 3 (1) ◽

pp. 3 ◽

Cited By ~ 1

Author(s):

Nosratollah Nezakatzgoo ◽

Janet Colli ◽

Matthew Mutter ◽

Sheg Aranmolate ◽

Robert Wake

Keyword(s):

Partial Nephrectomy ◽

Operative Time ◽

Harmonic Scalpel ◽

Oral Intake ◽

Pathological Examination ◽

Tumor Diameter ◽

Renal Masses ◽

Estimated Blood Loss ◽

Average Operative Time

The purpose of the present paper is to describe our technique and experience with retroperitoneal hand-assisted laparoscopic (HAL) nephrectomies as an alternative to the transperitoneal approach. Eight retroperitoneal HAL nephrectomies and one partial nephrectomy were performed. Several excisional techniques were employed incorporating the Harmonic scalpel or Ligasure device. Hemostatic agents were used to cover the renal defect. Surgical bolsters were sutured to the renal capsule with pleget reinforcements to aid in hemostasis. The average operative time was 210 min and estimated blood loss 110 mL. Mean change in hematocrit was 3 units and creatinine was 1 point. No patient required a transfusion. There were no major complications, with a mean follow-up of fourteen months. On average, patients resumed oral intake in 2 days, and were discharged in 3 days. Pathological examination revealed that two lesions were benign and seven malignant. Tumor diameter averaged 3 cm. There were no positive surgical margins. In conclusion, we have demonstrated the feasibility of retroperitoneal laparoscopic hand-assisted nephrectomy and partial nephrectomy surgery for solid renal masses.

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