Early impact of robot-assisted partial nephrectomy on renal function as assessed by renal scintigraphy

Abstract

To measure the early impact of robot-assisted partial nephrectomy (RAPN) on renal function as assessed by renal scan (Tc 99m-DTPA), addressing the issue of risk factors for ischemic damage to the kidney. All patients undergoing RAPN for cT1 renal masses between June 2013 and May 2014 were included in this prospective study. Renal function as expressed by glomerular filtration rate (GFR) was assessed by Technetium 99m-diethylenetriaminepentaacetic acid (Tc 99m-DTPA) renal scan preoperatively and postoperatively at 1 month in every patient. A multivariable analysis was used for the determination of independent factors predictive of GFR decrease of the operated kidney. Overall, 32 patients underwent RAPN in the time interval. Median tumor size, blood loss, and ischemia time were 4 cm, 200 mL, and 24 min, respectively. Two grade III complications occurred (postoperative bleeding in the renal fossa, urinoma). The GFR of the operated kidney decreased significantly from 51.7 ± 15.1 mL/min per 1.73 m(2) preoperatively to 40, 12 ± 12.4 mL/min per 1.73 m(2) 1 month postoperatively (p = 0.001) with a decrease of 22.4 %. On multivariable analysis, only tumor size (p = 0.05) was a predictor of GFR decrease of the operated kidney. Robotic-assisted partial nephrectomy had a detectable impact on early renal function in a series of relatively large tumors and prevailing intermediate nephrometric risk. A mean decrease of 22 % of GFR as assessed by renal scan in the operated kidney was found at 1 month postoperatively. In multivariable analysis, tumor size only was a significant predictor of renal function loss.

Predictors of new‐onset chronic kidney disease in patients managed surgically for T1a renal cell carcinoma: An Australian population‐based analysis

“…Patients with larger T1a tumors were more likely to develop CKD in the present study; but, stratification by nephrectomy type (Figure ) indicated that this positive association was present only for patients managed with PN. This is concordant with previous reports evaluating kidney functional changes using renal scintigraphy after PN . To ensure negative surgical margins, the amount of functional parenchyma removed during PN is determined by tumor size and complexity, whereas that is not the case with RN.…”

“…This is concordant with previous reports evaluating kidney functional changes using renal scintigraphy after PN. 38,39 To FIGURE 2 Associations between selected factors and new-onset chronic kidney disease (CKD) stratified by nephrectomy type. Adjusted odds ratios (OR) and 95% confidence intervals (CI) estimated using logistic regression.…”

Which factors can influence post-operative renal function preservation after nephron-sparing surgery for kidney cancer: a critical review

“…With regards to the ischemia technique, 32 studies used main renal artery clamping [ 8 – 10 , 12 , 14 – 17 , 19 , 20 , 25 – 28 , 32 – 36 , 40 , 41 , 42 , 46 – 49 , 51 , 52 , 54 , 56 , 57 , 58 ], 5 studies selective ischemia [ 21 – 24 , 30 ], 5 studies used both main renal artery and selective ischemia [ 37 , 38 , 43 , 45 , 53 ], 8 studies compared global ischemia and the off- clamp technique [ 11 , 13 , 18 , 29 , 31 , 39 , 50 , 55 ], and 1 study selective ischemia and the off-clamp technique [ 44 ]. Across the included trials, 42 studies used warm ischemia during the enucleoresection [ 8 – 15 , 17 , 19 – 24 , 26 – 34 , 36 – 45 , 47 – 50 , 53 , 54 , 55 , 58 ], while 2 trials utilised cold ischemia with iceball [ 35 , 52 ]; 8 studies used both the cold and warm ischemia [ 15 , 16 , 18 , 25 ...…”

“…Percentual eGFR variation was estimated in 49 studies, at a mean of 11.6 months of follow-up; values ranged from 0.7% to 37.1%, with a mean value of 12.5%. Fourteen studies reported percentual change of IRF on renal MAG- 3 scintigraphy [ 9 , 14 , 19 , 20 , 22 , 24 , 39 , 40 , 41 , 45 , 47 , 52 , 54 , 58 ]. At a mean follow-up of 7.9 months, IRF changes varied from 1.9% to 28%, with a mean IRF decrease of 13.3%.…”

“…A total of 17 studies performed a multivariable analysis to show which pre-operative or surgical technique variable significantly predicted the post-operative renal function outcome [ 8 , 10 , 11 , 12 , 14 , 17 , 18 , 19 , 25 , 32 , 39 , 40 , 47 , 49 , 52 , 56 , 57 ]. With regards to pre-operative data, 7 studies reported as a significant predictor of functional change the tumor size [ 8 , 12 , 25 , 40 , 47 , 56 , 57 ].…”