Impact of parenchymal loss on renal function after laparoscopic partial nephrectomy under warm ischemia

Bagheri, Fariborz; Pusztai, Csaba; Farkas, László; Kallidonis, Panagiotis; Buzogány, István; Szabó, Zsuzsanna; Lantos, János; Imre, Marianna; Farkas, Nelli; Szántó, Árpád

doi:10.1007/s00345-016-1798-2

Cited by 12 publications

(13 citation statements)

References 24 publications

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“…In our study, although the tumor size was larger with OPN than RAPN, the resected weight was much less in RAPN than OPN. Deterioration of renal function is related to the parenchymal loss accompanying the resected mass . Robotic surgery may also decrease blood loss during surgery.…”

Section: Discussionmentioning

confidence: 99%

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Robot‐assisted partial nephrectomy is associated with early recovery of renal function: Comparison of open, laparoscopic, and robot‐assisted partial nephrectomy using DTPA renal scintigraphy

Choi

Jung

You

et al. 2019

Journal of Surgical Oncology

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Objectives To compare the functional outcomes of open, laparoscopic, and robot‐assisted partial nephrectomy (OPN, LPN, and RAPN, respectively) using diethylene triamine penta‐acetic acid (DTPA). Methods We identified 610 patients who underwent partial nephrectomy for renal cell carcinoma (285 open partial nephrectomy [OPN], 96 laparoscopic partial nephrectomy [LPN], and 229 robot‐assisted partial nephrectomy [RAPN]) with preoperative and postoperative DTPA within 1 year. We excluded multiple renal masses and history of immunotherapy or chemotherapy. Predictive factors for glomerular filtration rate (GFR) reduction were assessed using multivariate linear regression. Results Postoperative complications and disease‐free survival were similar in the three groups. Within 1 postoperative year, OPN showed a significantly lower mean ipsilateral GFR than LPN and RAPN (28.9 versus 32.4 versus 32.7 mL/min/1.73 m 2, respectively; P < 0.001). RAPN was associated with a significantly higher total GFR than OPN within 1 year (76.6 versus 71.2 mL/min/1.73 m 2, respectively; P = 0.001). On multivariate analysis within 1 year, operation type (OPN versus RAPN: β = 2.82; 95% confidence interval, 1.17–4.48; P = 0.001) was significantly associated with GFR reduction. Conclusion There was no difference in postoperative complications and disease‐free survival among operation types. RAPN could help to promote earlier recovery of ipsilateral GFR than OPN.

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Section: Discussionmentioning

confidence: 99%

“…Deterioration of renal function is related to the parenchymal loss accompanying the resected mass. 16 Robotic surgery may also decrease blood loss during surgery. In our study, RAPN was associated with the lowest EBL, which agrees with previous research.…”

Section: Discussionmentioning

confidence: 99%

Robot‐assisted partial nephrectomy is associated with early recovery of renal function: Comparison of open, laparoscopic, and robot‐assisted partial nephrectomy using DTPA renal scintigraphy

Choi

Jung

You

et al. 2019

Journal of Surgical Oncology

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“…The oncological equivalence of PN to RN is well documented [6]. Commonly, transient vascular occlusion is performed during PN in order to facilitate tumor excision, control bleeding, reconstruct renal parenchyma, and avoid postoperative major complications [7]. This maneuver exposes the remnant kidney to warm ischemia-(WI-) reperfusion injury [7].…”

Section: Discussionmentioning

confidence: 99%

“…Commonly, transient vascular occlusion is performed during PN in order to facilitate tumor excision, control bleeding, reconstruct renal parenchyma, and avoid postoperative major complications [7]. This maneuver exposes the remnant kidney to warm ischemia-(WI-) reperfusion injury [7]. In addition, the excision of the renal tumor and the inner/outer renorrhaphy are stable factors that decrease functional renal parenchyma during PN [7].…”

Section: Discussionmentioning

confidence: 99%

“…This maneuver exposes the remnant kidney to warm ischemia-(WI-) reperfusion injury [7]. In addition, the excision of the renal tumor and the inner/outer renorrhaphy are stable factors that decrease functional renal parenchyma during PN [7]. So, renal ischemia is an important, modifiable risk factor which can affect renal function permanently or temporarily for approximately 6-12 weeks postoperatively [8,9].…”

Section: Discussionmentioning

confidence: 99%

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Multiple and bilateral sporadic renal cell carcinomas: A surgical challenge

Klapsis¹,

Katsimantas²,

Zervopoulos³

et al. 2018

European Urology Supplements

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Sporadic, synchronous, bilateral, or unilateral Renal Cell Carcinomas constitute a rare clinical entity. We report the case of a 68year-old male patient who presented in our department due to incidentally discovered multiple, bilateral renal tumors. Magnetic Resonance Imaging demonstrated cT1b renal tumors at the lower pole of each kidney and a cT1a renal tumor at the upper pole of the right kidney. The patient underwent transperitoneal, laparoscopic left partial nephrectomy with renal artery occlusion, histology revealed high-grade, pT1b, clear-cell renal cell carcinoma; however we observed decline of patient's estimated glomerular filtration rate postoperatively. Forty days postoperatively, he underwent open partial nephrectomy for the right sided tumors with manual compression of the renal parenchyma and no use of ischemia. Histology revealed high-grade, pT1a, clear-cell renal cell carcinoma at the upper pole of the right kidney and low-grade, pT1b, clear-cell renal cell carcinoma at the lower pole of the right kidney. There was no additional decline in the serum creatinine value postoperatively. The patient avoided permanent or temporary dialysis and 6 months postoperatively he demonstrated no recurrence on imaging and his renal function remained stable.

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Nephron sparing surgery for renal cell carcinoma up to 7 cm in the context of guideline development: a contribution of healthcare research

et al. 2016

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This study again demonstrated that the PADUA-score is a robust predictor of technical feasibility and treatment outcome for open PN. Consistent implementation of guidelines for nephron sparing surgery in RCC ≤7 cm is possible even in the setting of a training clinic and need not be associated with compromised treatment quality despite the increasing level of difficulty. Depending on the author, there are various definitions of trifecta-outcome. A uniform trifecta-concept would be desirable.

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Impact of parenchymal loss on renal function after laparoscopic partial nephrectomy under warm ischemia

Abstract: After LPN of small renal mass, decline in renal function is primarily attributed to parenchymal loss caused by tumor resection and suturing of the normal parenchyma rather than the RI.

Cited by 12 publications

References 24 publications

Robot‐assisted partial nephrectomy is associated with early recovery of renal function: Comparison of open, laparoscopic, and robot‐assisted partial nephrectomy using DTPA renal scintigraphy

Robot‐assisted partial nephrectomy is associated with early recovery of renal function: Comparison of open, laparoscopic, and robot‐assisted partial nephrectomy using DTPA renal scintigraphy

Multiple and bilateral sporadic renal cell carcinomas: A surgical challenge

Nephron sparing surgery for renal cell carcinoma up to 7 cm in the context of guideline development: a contribution of healthcare research

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