Impact of Curative Effect of Laparoscopic and Open Partial Nephrectomy for Complex Renal Tumours on Renal Function

IntroductionPartial nephrectomy is a standard of care for non-metastatic renal tumours when technically feasible. Despite the increased use of partial nephrectomy, intraoperative techniques that lead to optimal renal function after surgery have not been rigorously studied. Clamping of the renal hilum to prevent bleeding during resection causes temporary renal ischaemia. The internal temperature of the kidney may be lowered after the renal hilum is clamped (renal hypothermia) in an attempt to mitigate the effects of ischaemia. Our objective is to determine if renal hypothermia during open partial nephrectomy results in improved postoperative renal function at 12 months following surgery as compared with warm ischaemia (no renal hypothermia).Methods and analysesThis is a multicentre, randomised, single-blinded controlled trial comparing renal hypothermia versus no hypothermia during open partial nephrectomy. Due to the nature of the intervention, complete blinding of the surgical team is not possible; however, surgeons will be blinded until the time of hilar clamping. Glomerular filtration will be based on plasma clearance of a radionucleotide, and differential renal function will be based on renal scintigraphy. The primary outcome is overall renal function at 12 months measured by the glomerular filtration rate (GFR). Secondary outcomes include change in GFR, GFR of the affected kidney, change in GFR of the affected kidney, serum creatinine, haemoglobin, spot urine albumin to creatinine ratio, quality of life and postoperative complications. Data will be collected at baseline, immediately postoperatively and at 3, 6, 9 and 12 months postoperatively.Ethics and disseminationEthics approval was obtained for all participating study sites. Results of the trial will be submitted for publication in a peer-reviewed journal.Trial registration numberNCT01529658; Pre-results.

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The association between the anatomical features of renal tumours and the functional outcomes of robot-assisted partial nephrectomy

Canadian Urological Association Journal ◽

10.5489/cuaj.1642 ◽

2014 ◽

Vol 8 (11-12) ◽

pp. 810 ◽

Cited By ~ 3

Author(s):

Jeong Woo Lee ◽

Sung Yong Cho ◽

Chanhoo Jeon ◽

Kyungtae Ko ◽

Hyeon Hoe Kim

Keyword(s):

Renal Function ◽

High Risk ◽

Functional Outcome ◽

Partial Nephrectomy ◽

Magnetic Resonance Images ◽

Robot Assisted ◽

Computed Tomography Images ◽

Postoperative Renal Function ◽

Renal Tumours ◽

Clinical Records

Introduction: We evaluated the the association between PADUA scores and postoperative renal function (after robot-assisted partial nephrectomy [RAPN]) and between PADUA scores and warm ischemic time (during RAPN).Methods: We reviewed the clinical records of 106 patients who underwent RAPN for a single localized renal tumour between April 2009 and June 2012. Postoperative renal function was evaluated using estimated glomerular filtration rate (eGFR) in 85 patients who were followed for at least 6 months. PADUA scores for renal tumours were calculated using contrast-enhanced computed tomography images, if needed, along with magnetic resonance images in some cases.Results: A PADUA score ≥10 and WIT ≥30 minutes were observed in 18 (17.0%) and 51 (48.1%) cases, respectively. PADUA scores were significantly correlated with WIT (p = 0.019) and percent change in eGFR at 6 months postoperatively (p = 0.005). PADUA score (continuous variable, odds ratio [OR] 1.694, p = 0.007) and the high-risk group (PADUA score ≥10) (OR 5.429; p = 0.020) were significantly associated with a WIT of ≥30 minutes by multivariate analysis. A 1-point increase in the PADUA score was associated with an eGFR decrease of >20% at 6 months after RAPN (OR 1.799; p = 0.076). In addition, a PADUA score ≥10, or high risk, (OR 13.965; p = 0.003) was an independent predictor of an eGFR decrease of >20% at 6 months after RAPN.Conclusions: The PADUA classification can reliably predict WIT and postoperative renal functional outcome after RAPN. Furthermore, the study suggests that anatomical aspects of renal tumours are associated with functional outcome after RAPN.

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1447 LAPAROSCOPIC VS OPEN PARTIAL NEPHRECTOMY FOR T1 RENAL TUMOURS: EVALUATION OF LONG-TERM ONCOLOGICAL AND FUNCTIONAL OUTCOMES IN 340 PATIENTS

The Journal of Urology ◽

10.1016/j.juro.2013.02.2801 ◽

2013 ◽

Vol 189 (4S) ◽

Author(s):

Giovannalberto Pini ◽

Luigi Ascalone ◽

Domenico Veneziano ◽

Stefano Alba ◽

Paolo Fornara ◽

...

Keyword(s):

Partial Nephrectomy ◽

Functional Outcomes ◽

Open Partial Nephrectomy ◽

Renal Tumours

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Multifocal renal tumours: A matched comparative study between robotic and open partial nephrectomy

European Urology Open Science ◽

10.1016/s2666-1683(20)32637-9 ◽

2020 ◽

Vol 19 ◽

pp. e139-e140

Author(s):

C. Debard ◽

N. Doumerc ◽

C. Dariane ◽

F. Bruyère ◽

J. Rizk ◽

...

Keyword(s):

Comparative Study ◽

Partial Nephrectomy ◽

Open Partial Nephrectomy ◽

Renal Tumours

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Open Partial Nephrectomy for Pediatric Renovascular Hypertension

The Scientific World JOURNAL ◽

10.1100/tsw.2009.40 ◽

2009 ◽

Vol 9 ◽

pp. 287-290 ◽

Cited By ~ 2

Author(s):

Matt S. Ashley ◽

Gregory Moneta ◽

Siamak Daneshmand

Keyword(s):

Renal Function ◽

Partial Nephrectomy ◽

Renovascular Hypertension ◽

Radical Nephrectomy ◽

Antihypertensive Medication ◽

Alternative Therapy ◽

Lower Pole ◽

Renal Veins ◽

Open Partial Nephrectomy ◽

Arterial Bypass

Pediatric renovascular hypertension is typically managed with revascularization, angioplasty, or radical nephrectomy. We describe the case of a 13-year-old boy with medically refractory renovascular hypertension who presented to our institution after a failed arterial bypass. Subsequent angiography and renin sampling of the segmental renal veins suggested that the lower pole of the kidney was affected exclusively by the relative hypoperfusion. We proceeded with an open partial nephrectomy in order to excise the affected region of the kidney, while preserving maximum renal function. The patient was normotensive off all antihypertensive medication and without complications 8 months postoperatively. We believe that partial nephrectomy is a reasonable treatment for children with renovascular hypertension secondary to segmental hypoperfusion, and it should be considered as alternative therapy.

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Comparison of the Loss of Renal Function after Cold Ischemia Open Partial Nephrectomy, Warm Ischemia Laparoscopic Partial Nephrectomy and Laparoscopic Partial Nephrectomy Using Microwave Coagulation

Current Urology ◽

10.1159/000343524 ◽

2012 ◽

Vol 6 (3) ◽

pp. 118-123 ◽

Cited By ~ 2

Author(s):

Takashi Kawahara ◽

Ryoko Sakata ◽

Kimiko Kawahara ◽

Hiroki Ito ◽

Yasuhide Miyoshi ◽

...

Keyword(s):

Renal Function ◽

Partial Nephrectomy ◽

Warm Ischemia ◽

Laparoscopic Partial Nephrectomy ◽

Cold Ischemia ◽

Open Partial Nephrectomy ◽

Microwave Coagulation

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Open partial nephrectomy for renal tumours: current status

BJU International ◽

10.1111/j.1464-410x.2005.05197.x ◽

2005 ◽

Vol 95 (s2) ◽

pp. 35-40 ◽

Cited By ~ 59

Author(s):

Andrew C. Novick ◽

Ithaar Derweesh

Keyword(s):

Partial Nephrectomy ◽

Current Status ◽

Open Partial Nephrectomy ◽

Renal Tumours

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Polyethylene glycol-coated collagen patch (hemopatch®) in open partial nephrectomy

World Journal of Urology ◽

10.1007/s00345-021-03827-x ◽

2021 ◽

Author(s):

Michael Staehler ◽

S. Rodler ◽

M. Schott ◽

J. Casuscelli ◽

C. Stief ◽

...

Keyword(s):

Renal Function ◽

Polyethylene Glycol ◽

Blood Loss ◽

Partial Nephrectomy ◽

Low Complexity ◽

High Complexity ◽

Open Partial Nephrectomy ◽

Duration Of Surgery ◽

Coated Collagen

Abstract Purpose To describe the results of a polyethylene glycol-coated collagen patch, Hemopatch® on blood loss, surgical time and renal function in partial nephrectomy (PN) for renal cell carcinoma (RCC). Methods Out of a single surgeon cohort of n = 565 patients undergoing conventional open PN (CPN) between 01/2015 and 12/2017 at the University of Munich a consecutive subgroup (n = 42) was operated on using a polyethylene glycol-coated collagen-based sealant Hemopatch® (Baxter International Inc., Deerfield, IL, USA) (HPN). Results Median age was 65.2 years (range 12.7–95.2) with median follow-up of 9.43 months (0.03–49.15). Baseline renal function (CKD-EPI) was 78.56 ml/min/1.73 m2 (range 20.38–143.09) with a non-significant decline to 74.78 ml/min/1.73 m2 (range 3.75–167.74) at follow-up. In CPN 46% had low complexity, 33% moderate complexity and 20% high complexity lesions with 33% low, 40% moderate and 27% high complexity masses in HPN. Median tumor size was 4.3 cm (range 1–38 cm) in CPN with 4.8 cm (range 3.8–18.3 cm) with HPN, p = 0.293. Median blood loss and duration of surgery was significantly lower in the HPN group vs. CPN (146 ml ± 195 vs. 114 ml ± 159 ml; p = 0.021; 43 min ± 27 for HPN vs. 53 min ± 49; p = 0.035) with no difference in clamping time (12.6 min ± 8.6 for HPN vs. 12.0 min ± 9.5; p = 0.701). Conclusions Hemopatch® supported renoraphy shows promising results compared to standard renoraphy in PN. No side effects were seen. Further studies should evaluate the prevention of arterio-venous or urinary fistulas. In complex partial nephrectomies Hemopatch® supported renoraphy should be considered.

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