Intraoperative Mannitol Use Does Not Improve Long-term Renal Function Outcomes After Minimally Invasive Partial Nephrectomy

Power, Nicholas; Maschino, Alexandra C.; Savage, Caroline; Silberstein, Jonathan L.; Thorner, Daniel; Tarin, Tatum; Wong, Alice; Touijer, Karim; Russo, Paul; Coleman, Jonathan

doi:10.1016/j.urology.2011.11.064

Cited by 44 publications

(31 citation statements)

References 20 publications

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“…They, too, did not find any evidence that mannitol was significantly associated with improved renal function recovery over time. 3 Multivariate analysis in the present study supports the notion that ischemia time is an independent predictor of renal function after PN. 25 A recent study suggested that the amount of preserved parenchyma and its baseline functionality could be the primary determinants of ultimate renal function after PN, although type and duration of ischemia remain the most important factors.…”

Section: Discussionsupporting

confidence: 86%

“…Mannitol has traditionally been administered before PN to reduce ischemic renal damage as an intravascular volume expander with a purported function of free radical scavenging, as well as being an osmotic diuretic. [1][2][3] However, we do not have any high-level clinical evidence of its effectiveness. In fact, a potential deleterious effect of mannitol related to increased tubular oxygen demand has been reported.…”

Section: Introductionmentioning

confidence: 99%

“…In fact, a potential deleterious effect of mannitol related to increased tubular oxygen demand has been reported. [2][3][4] In the present study, we analyzed the effect of mannitol during OPN for renal cancer in solitary kidneys on postoperative renal function by comparing that between the patients who received it and those who did not.…”

Section: Introductionmentioning

confidence: 99%

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Mannitol has no impact on renal function after open partial nephrectomy in solitary kidneys

et al. 2013

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Abbreviations & AcronymsAbstract: Mannitol has been administered during partial nephrectomy as a renal protective agent for ischemic damage. However, we do not have any high-level clinical evidence of its effectiveness. The aim of the present study was to evaluate the effect of mannitol during open partial nephrectomy by comparing the postoperative renal function of patients who received it and those who did not. We retrospectively reviewed the records of 55 patients who underwent open partial nephrectomy for renal cancer in a solitary kidney from January 1990 to December 2012, and who were followed up postoperatively for at least 6 months. Of the 55 patients, mannitol was given to 20 patients (group M+) and not to the other 35 patients (group M−). We compared not only the postoperative estimated glomerular filtration rate, but also its decrease rate and the incidence of acute kidney injury requiring dialysis in the two groups. There were no significant differences in perioperative patient characteristics between the two groups. Mannitol made no significant difference in both the postoperative estimated glomerular filtration rate and its decrease rate at any point within 6 months of the postoperative period. The incidence of acute kidney injury requiring dialysis was one (5.0%) in group M+ and two (5.7%) in group M−. These findings suggest that there might be no advantage from the administration of mannitol during open partial nephrectomy.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

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Mannitol has no impact on renal function after open partial nephrectomy in solitary kidneys

et al. 2013

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“…Many surgeons prefer to use mannitol and/or furosemide during PN, which may optimize reperfusion and increase diuresis [57]. However, several recent studies do not support the use of mannitol during PN [58], even in solitary kidneys [59]. Cooling with ice slush is the classical strategy for cold ischemia during OPN [56], but has also been applied in minimally invasive approaches [60,61].…”

Section: Evidence Synthesismentioning

confidence: 99%

A Literature Review of Renal Surgical Anatomy and Surgical Strategies for Partial Nephrectomy

et al. 2015

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Context A detailed understanding of renal surgical anatomy is necessary to optimize preoperative planning and operative technique and provide a basis for improved outcomes. Objective To evaluate the literature regarding pertinent surgical anatomy of the kidney and related structures, nephrometry scoring systems, and current surgical strategies for partial nephrectomy (PN). Evidence acquisition A literature review was conducted. Evidence synthesis Surgical renal anatomy fundamentally impacts PN surgery. The renal artery divides into anterior and posterior divisions, from which approximately five segmental terminal arteries originate. The renal veins are not terminal. Variations in the vascular and lymphatic channels are common; thus, concurrent lymphadenectomy is not routinely indicated during PN for cT1 renal masses in the setting of clinically negative lymph nodes. Renal-protocol contrast-enhanced computed tomography or magnetic resonance imaging is used for standard imaging. Anatomy-based nephrometry scoring systems allow standardized academic reporting of tumor characteristics and predict PN outcomes (complications, remnant function, possibly histology). Anatomy-based novel surgical approaches may reduce ischemic time during PN; these include early unclamping, segmental clamping, tumor-specific clamping (zero ischemia), and unclamped PN. Cancer cure after PN relies on complete resection, which can be achieved by thin margins. Post-PN renal function is impacted by kidney quality, remnant quantity, and ischemia type and duration. Conclusions Surgical renal anatomy underpins imaging, nephrometry scoring systems, and vascular control techniques that reduce global renal ischemia and may impact post-PN function. A contemporary ideal PN excises the tumor with a thin negative margin, delicately secures the tumor bed to maximize vascularized remnant parenchyma, and minimizes global ischemia to the renal remnant with minimal complications. Patient summary In this report we review renal surgical anatomy. Renal mass imaging allows detailed delineation of the anatomy and vasculature and permits nephrometry scoring, and thus precise, patient-specific surgical planning. Novel off-clamp techniques have been developed that may lead to improved outcomes.

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“…There are no randomised trials supporting its use during NSS, and furthermore, there have been studies demonstrating no benefit in renal function within six months of NSS with mannitol use. 33 The mean peri-operative blood loss is similar in both groups, and no significant difference was seen. Similar results are seen in current case series.…”

Section: Discussionmentioning

confidence: 78%

Laparoscopic and open partial nephrectomy: a UK centre's experience

Youssef

Smith

Oakley

2014

Journal of Clinical Urology

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Introduction: Laparoscopy allows minimally invasive approaches for procedures traditionally performed openly, with associated lower morbidity. Nephron-sparing surgery (NSS) is mostly regarded as an open procedure because laparoscopic partial nephrectomy (LPN) is technically challenging. We evaluated our centre's experience with LPN and open partial nephrectomy (OPN). Methods: All patients over five years (2005)(2006)(2007)(2008)(2009)(2010) undergoing NSS were identified retrospectively from our operating room management information system. Case notes, diagnostic and post-operative surveillance imaging were reviewed. Post-operative morbidity, histopathology and serum full blood count and urea and electrolyte reports were recorded. Results: A total of 97 OPNs and 23 LPNs were performed. Median length of stay was six days for OPNs and three days for LPNs (p = 0.005). Mean drop in haemoglobin (Hb) was 2.6 g/dl for both OPNs and LPNs. No significant difference in transfusion rates was observed. Median warm ischaemia time (WIT) for OPNs was 14 minutes and 32 minutes for LPNs (p < 0.0001). No significant difference was seen in changes from baseline serum creatinine when comparing OPNs with LPNs at day 1 (p = 0.7572) and at 12 months (p = 0.7406) post-operatively. Surgical margins were positive in 20 (21.5%) OPNs and negative in all LPNs (p = 0.038). One patient developed local recurrence following OPN (clear margins) and two patients developed distant metastases. Conclusions: Benefits of LPN include shorter hospital stay and satisfactory long-term preservation of renal function, despite longer WITs. This demonstrates the benefits of LPNs in patients with single exophytic renal tumours performed by highly experienced, regionally selected laparoscopists.

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Intraoperative Mannitol Use Does Not Improve Long-term Renal Function Outcomes After Minimally Invasive Partial Nephrectomy

Cited by 44 publications

References 20 publications

Mannitol has no impact on renal function after open partial nephrectomy in solitary kidneys

Mannitol has no impact on renal function after open partial nephrectomy in solitary kidneys

A Literature Review of Renal Surgical Anatomy and Surgical Strategies for Partial Nephrectomy

Laparoscopic and open partial nephrectomy: a UK centre's experience

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