Multivariate analysis of the factors involved in loss of renal differential function after laparoscopic partial nephrectomy: a role for warm ischemia time

Background: Partial nephrectomy (PN) is now the gold standardfor the surgical treatment of small renal masses. We evaluated theeffect of WIT and other factors on RDF assessed by preoperativeand postoperative renal scintigraphy.Methods: Between 2003 and 2008, 182 consecutive laparoscopicPN (LPN) were performed in an academic centre. Among those,56 had mercaptoacetyl triglycine (MAG3) lasix renal scintigraphypreoperatively and postoperatively.Results: Medians for age, preoperative estimated glomerular filtrationrate and computed tomography scan tumour size were 62years, 82 mL/min/1.73m2 and 26 mm, respectively. Median WITand preoperative RDF were 30 minutes and 50%, respectively.Median loss of RDF after surgery was 14%. Linear regression curvesshowed that loss in RDF rate was 0.2% per minute when WIT was<30 minutes and 0.7% per minute when WIT was ≥30 minutes.In multivariate analysis, length of WIT and endophytic tumourlocation were associated with a statistically significant loss of RDF(p < 0.05), but only in the group who experienced >30 minutesof WIT.Interpretation: Our results suggest that the factors associated withloss of RDF are not the same before and after 30 minutes of WITand that the rate of loss in RDF increases after 30 minutes. Since,the effect of WIT is small up to 30 minutes, we believe that surgeryshould focus on limiting the resection of normal parenchymaand to ensure negative margins and hemostasis, rather than onpremature unclamping.

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1185 NATIONAL UTILIZATION OF PARTIAL NEPHRECTOMY BEFORE AND AFTER THE ESTABLISHMENT OF AUA GUIDELINES FOR THE TREATMENT OF SMALL RENAL MASSES

The Journal of Urology ◽

10.1016/j.juro.2013.02.2539 ◽

2013 ◽

Vol 189 (4S) ◽

Author(s):

Marc A. Bjurlin ◽

Dawn Walter ◽

William C. Huang ◽

James S. Wysock ◽

Ganesh Sivarajan ◽

...

Keyword(s):

Partial Nephrectomy ◽

Small Renal Masses ◽

Renal Masses ◽

Before And After

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1398 Active Surveillance Vs. Partial Nephrectomy in Small Renal Masses: Overall and Cancer Specific Survival in A Retrospective Single Centre Study

British Journal of Surgery ◽

10.1093/bjs/znab259.1109 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

S Shafi ◽

O Kouli ◽

G Nabi

Keyword(s):

Renal Cell Carcinoma ◽

Multivariate Analysis ◽

Cell Carcinoma ◽

Partial Nephrectomy ◽

Active Surveillance ◽

Renal Cell ◽

Tumour Size ◽

Cancer Specific Survival ◽

Renal Masses ◽

Elderly Individuals

Abstract Introduction Currently, the gold standard for T1a renal cell carcinoma treatment is partial nephrectomy (PN). However, active surveillance (AS) is increasing in elderly individuals with co-morbidities. Our hypothesis was that individuals choosing active surveillance would have similar cancer specific survival as partial nephrectomy. Method This retrospective study used electronic notes to collect patient data presenting with T1a renal cell carcinoma, identified over a 15-year period. Primary outcomes were to compare the survival outcomes of these patients while being related to their comorbidities using the Charlson Comorbidity Index (CCI). Results 183 patients were identified with 62 (35%) and 121 (65%) undergoing PN and AS respectively. Patients treated with AS were older (mean age of 66 years vs 58 years; P < 0.001) and had a higher CCI (median CCI 3 vs 2; P = 0.001). Overall, a total of 4 (6.5%) and 55 (45.5%) patients died from any cause after PN and AS respectively, with deaths attributed to kidney cancer was 2 (3.2%), and 10 (8.2%) respectively. Multivariate analysis showed only age >70 affected overall survival independently between the two groups (HR 5.85; CI 3.29-10.42; P < 0.001). Tumour size showed to be the only independent variable on cancer specific survival (HR 2.51; CI 1.14 -5.53; P = 0.023). No difference was seen between the treatment options in multivariate analysis in both overall and cancer specific survival. Conclusions The study agreed with the hypothesis of similar cancer specific survival. Highlighting for elderly individuals with significant co-morbidities, there is no observed benefit for undergoing partial resection.

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V708: Partial Nephrectomy for Small Renal Masses: An Emerging Quality of Care Concern?

The Journal of Urology ◽

10.1016/s0022-5347(18)32944-6 ◽

2006 ◽

Vol 175 (4S) ◽

pp. 229-229

Author(s):

David C. Miller ◽

John M. Hollingsworth ◽

Khaled S. Hafez ◽

Stephanie Daignault ◽

Brent K. Hollenbeck

Keyword(s):

Quality Of Care ◽

Partial Nephrectomy ◽

Small Renal Masses ◽

Renal Masses

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Faculty Opinions recommendation of Active surveillance of small renal masses offers short-term oncological efficacy equivalent to radical and partial nephrectomy.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717948514.793453573 ◽

2012 ◽

Author(s):

Robert Huddart

Keyword(s):

Partial Nephrectomy ◽

Active Surveillance ◽

Short Term ◽

Small Renal Masses ◽

Renal Masses

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1526 ECONOMIC AND CLINICAL CONSEQUENCES OF NEW ONSET POST-OPERATIVE CHRONIC KIDNEY DISEASE FOLLOWING RADICAL AND PARTIAL NEPHRECTOMY IN THE MANAGEMENT OF SMALL RENAL MASSES

The Journal of Urology ◽

10.1016/j.juro.2011.02.1519 ◽

2011 ◽

Vol 185 (4S) ◽

Cited By ~ 2

Author(s):

Steven L Chang ◽

Lauren E Cipriano ◽

Steven M Brunelli ◽

Benjamin I Chung

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Partial Nephrectomy ◽

Small Renal Masses ◽

Renal Masses ◽

Clinical Consequences ◽

New Onset

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Intraoperative ultrasound in robot-assisted partial nephrectomy: State of the art

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2018.3.195 ◽

2018 ◽

Vol 90 (3) ◽

pp. 195-198 ◽

Cited By ~ 3

Author(s):

Giacomo Di Cosmo ◽

Enrica Verzotti ◽

Tommaso Silvestri ◽

Andrea Lissiani ◽

Roberto Knez ◽

...

Keyword(s):

Partial Nephrectomy ◽

State Of The Art ◽

Short Review ◽

Robot Assisted ◽

Small Renal Masses ◽

Renal Masses ◽

Ischemia Time ◽

Oncological Safety ◽

Nephron Sparing ◽

Operative Ultrasound

Introduction: Nephron-sparing surgery (NSS) is of one of the most studied fields in urology due to the balancing between renal function preservation and oncological safety of the procedure. Aim of this short review is to report the state of the art of intra-operative ultrasound as an operative tool to improve localization of small renal masses partially or completely endophytic during robotassisted partial nephrectomy (RAPN). Material and methods: We performed a literature review by electronic database on Pubmed about the use of intra-operative US in RAPN to evaluate the usefulness and the feasibility of this procedure. Results: Several studies analyzed the use of different US probes during RAPN. Among them some focused on using contrastenhanced ultra sonography (CEUS) for improving the dynamic evaluation of microvascular structure allowing the reduction of ischemia time (IT). We reported that nowaday the use of intraoperative US during RAPN could be helpful to improve the preservation of renal tissue without compromising oncological safety. Moreover, during RAPN there is no need for assistant to hand the US probe increasing surgeon autonomy. Conclusions: The use of a robotic ultrasound probe during partial nephrectomy allows the surgeon to optimize tumor identification with maximal autonomy, and to benefit from the precision and articulation of the robotic instrument during this key step of the partial nephrectomy procedure. Moreover US could be useful to reduce ischemia time (IT). The advantages of nephron-sparing surgery over radical nephrectomy is well established with a pool of data providing strong evidence of oncological and survival equivalency. With the progressive growth of robot-assisted partial nephrectomy (RAPN) techniques, the use of several tools has been progressively developed to help the surgeon in the identification of masses and its vascular net. In this short review we tried to analyze the current use of intra-operative ultrasound as an operative tool to improve localization of small renal masses partially or completely endophytic during RAPN.

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