Assessment of surgical outcomes of off-clamp open partial nephrectomy without renorrhaphy for ≥T1b renal tumours

Nakamura, Masaki; Ambe, Yoshiki; Teshima, Teruki; Shirakawa, Norihide; Inatsu, Hiroki; Amakawa, Ryo; Inoue, Yasushi; Yoshimatsu, Tadashi; Imai, Shunsuke; Kusakabe, Makoto; Morikawa, Teppei; Kameyama, Shuji; Shiga, Yoshiyuki

doi:10.1007/s10147-021-01966-0

Cited by 4 publications

(8 citation statements)

References 22 publications

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“…We have recently reported the surgical results of off-clamp, non-renorrhaphy open partial nephrectomy for ≥T1b renal tumors (8). The perioperative eGFR preservation at 1 month and 3 months after surgery was 88.9% and 87.3%, respectively (8). In laparoscopic or robotic surgeries, perioperative eGFR preservation was 96.9-100% for highly selected patients (18)(19)(20).…”

Section: Discussionmentioning

confidence: 99%

“…There are limited data on perioperative renal function during combined off-clamp and non-renorrhaphy partial nephrectomy. We have recently reported the surgical results of off-clamp, non-renorrhaphy open partial nephrectomy for ≥T1b renal tumors ( 8 ). The perioperative eGFR preservation at 1 month and 3 months after surgery was 88.9% and 87.3%, respectively ( 8 ).…”

Section: Discussionmentioning

confidence: 99%

“…We used monopolar SOFT COAG (VIO300D, ERBE, Germany) with a normal saline drip for hemostasis. Surgical techniques have been described previously ( 8 ). In partial nephrectomy, the renal parenchyma was repeatedly separated bluntly using a spatula-shaped tip of a monopolar device, followed by soft coagulation of the separated renal parenchyma and bleeding blood vessels.…”

Section: Methodsmentioning

confidence: 99%

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Predictive factors for postoperative renal function after off-clamp, non-renorrhaphy partial nephrectomy

Nakamura¹,

Kameyama²,

Ambe³

et al. 2022

Transl Androl Urol

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Background: There is limited information on perioperative renal function during off-clamp, nonrenorrhaphy open partial nephrectomy. Therefore, this retrospective study aimed to identify predictive factors of perioperative decline in renal function after off-clamp, non-renorrhaphy open partial nephrectomy. Methods: Clinical records of 138 patients with renal tumors who underwent off-clamp, non-renorrhaphyopen partial nephrectomy at our institution were reviewed. Off-clamp, non-renorrhaphy partial nephrectomy was performed using a soft coagulation system. Perioperative estimated glomerular filtration rate (eGFR) preservation was calculated, and predictors were identified using multivariate regression analysis at 5 days, 1 month, and 3 months after surgery. Results:The median operation time was 122 minutes, and the median volume of estimated blood loss was 155 mL. The mean eGFR preservation at 5 days, 1 month, and 3 months after surgery was 95.3%, 91.0%, and 90.7%, respectively. Estimated blood loss was an independent predictor of perioperative decline in eGFR

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Predictive factors for postoperative renal function after off-clamp, non-renorrhaphy partial nephrectomy

Nakamura¹,

Kameyama²,

Ambe³

et al. 2022

Transl Androl Urol

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“…All patients underwent retroperitoneal open partial nephrectomy as described previously [ 2 ]. Briefly, a partial nephrectomy was performed by blunt separation and sharp cutting, followed by hemostasis with monopolar SOFT COAG (VIO300D, ERBE, Germany).…”

Section: Methodsmentioning

confidence: 99%

Predictors of renal function deterioration at one year after off-clamp non-renorrhaphy partial nephrectomy

Nakamura,

Kameyama,

Tsuru

et al. 2024

PLoS ONE

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Background Preservation of renal function is an important goal in renal cell carcinoma-related surgery. Although several case-dependent techniques for renal pedicle clamping and hemostasis have been used, their effects on long-term renal function are controversial. Methods The clinical records of 114 patients who underwent off-clamp non-renorrhaphy open partial nephrectomy at our hospital were retrospectively reviewed. Perioperative estimated glomerular filtration rate (eGFR) preservation was calculated, and predictors of eGFR decline 12 months post-surgery and overtime deterioration of renal function were identified using a multivariate regression analysis. Results The median patient age was 65 years, and the median tumor size was 27 mm. The mean eGFR preservation at 1, 3, and 12 months post-surgery were 90.1%, 89.0%, and 86.9%, respectively. eGFR decline at 1 and 3 months were associated with poor eGFR preservation at 12 months with the odds ratio (95% confidence interval (CI)) of 1.97 and 3.157, respectively. Multivariate regression analyses revealed that tumor size was an independent predictor of eGFR decline at 12 months. Among 65 patients with eGFR preservation over 90% at 1 month post-surgery, eGFR value of 28 patients deteriorated below 90% at 12 months post-surgery compared with preoperative eGFR. Tumor size and eGFR preservation at 1 month were independent predictors of long-term renal function deterioration. Conclusion Tumor size predicted eGFR decline 12 months post-surgery. Only a mild decline in eGFR was observed between 3 and 12 months after open partial nephrectomy. Tumor size and eGFR preservation at 1 month predicted the deterioration of renal function over time.

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“…While transient clamping of the renal artery is typically a key part of the procedure, surgical techniques can vary among different centres [ 4 , 5 ] and may include RAPN, open partial nephrectomy, or laparoscopic radical nephrectomy, depending on the size of the tumour [ 6 ]. The use of renal pedicle clamping during partial nephrectomy has been debated due to its potential benefits, such as reduced blood loss and better visualization of the tumour margin, as well as its potential drawbacks, such as the risk of injury to the renal pedicle, spasms in the renal arteries, increased risk of postoperative adhesions and adjacent organ injuries [ 7 ], and potential loss of renal function. After nephron-sparing surgery (NSS), the treated kidney typically experiences a 20% decrease in function immediately after the surgery.…”

Section: Introductionmentioning

confidence: 99%

Off-clamp robotic-assisted partial nephrectomy: surgical experience from a single center

2023

Cent european J Urol

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Introduction Robot-assisted partial nephrectomy (RAPN) is a minimally invasive treatment for localized renal tumours, which can sometimes result in extended warm ischaemic time and serious complications. This study reports on surgical outcomes including feasibility, positive margins, and complications during and after surgery. Material and methods From January 2011 to November 2022, a single centre performed off-clamp sutureless RAPN on 287 patients. The study recorded preoperative patient characteristics, estimated glomerular filtration rate, and tumour features according to the preoperative aspects and dimensions used for an anatomical (PADUA) classification, and utilized the RENAL nephrometry scoring system. Intraoperative details and complications were documented. Postoperative complications within 30 days were classified according to the Clavien-Dindo system. Follow-up appointments were scheduled at 1, 3, and 6 months in the first year, followed by subsequent appointments every 6 months, and then annually. Results The study included 145 males and 142 females, with a mean age of 58.9 years and a mean body mass index of 26.7 kg/m 2 . The mean PADUA score was 8.3, the average console time was 83 minutes, and the estimated blood loss was 280 mL. The average hospital stay was 3 days, and no intraoperative complications were observed. However, 4 patients (1.4%) experienced post-operative haemorrhage that required laparotomy (Clavien-Dindo stage IIIB), and 4 patients (1.4%) had positive surgical margins. Conclusions Off-clamp selective arterial clamping during minimally invasive partial nephrectomy is a safe and feasible approach for small renal tumours. Further randomized prospective studies are required to confirm if RAPN without clamping offers any renal functional benefits and reduces perioperative bleeding complications.

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Assessment of surgical outcomes of off-clamp open partial nephrectomy without renorrhaphy for ≥T1b renal tumours

Cited by 4 publications

References 22 publications

Predictive factors for postoperative renal function after off-clamp, non-renorrhaphy partial nephrectomy

Predictive factors for postoperative renal function after off-clamp, non-renorrhaphy partial nephrectomy

Predictors of renal function deterioration at one year after off-clamp non-renorrhaphy partial nephrectomy

Off-clamp robotic-assisted partial nephrectomy: surgical experience from a single center

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