Long-Term Oncological and Functional Outcomes of Partial Nephrectomy in Solitary Kidneys

Berczi, Csaba; Ben, Thomas; Bacsó, Zsolt; Flaskó, Tibor

doi:10.1016/j.clgc.2015.11.014

Cited by 9 publications

(7 citation statements)

References 9 publications

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“…Quantitative morphological methods are preferable. However, as indicated by another study, the serum creatinine levels may be normal because the right kidney was unaffected 27 . Hence, a single kidney model should be used for studies measuring global renal function after warm ischemia 28 .…”

Section: ■ Discussionmentioning

confidence: 99%

The relationship between renal warm ischemia time and glomerular loss. An experimental study in a pig model

et al. 2017

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The relationship between renal warm ischemia time and glomerular loss. An experimental study in a pig model 1 Acta Cir. Bras. 2017;32(5):334-341 Abstract Purpose: To investigate the glomerular number after different warm ischemia times. Methods: Thirty two pigs were assigned into four groups. Three groups (G10, G20, and G30) were treated with 10, 20, and 30 minutes of left renal warm ischemia. The sham group underwent the same surgery without renal ischemia. The animals were euthanized after 3 weeks, and the kidneys were collected. Right kidneys were used as controls. The kidney weight, volume, cortical-medullar ratio, glomerular volumetric density, volume-weighted mean glomerular volume, and the total number of glomeruli per kidney were obtained. Serum creatinine levels were assessed pre and postoperatively. Results: Serum creatinine levels did not differ among the groups. All parameters were similar for the sham, G10, and G20 groups upon comparison of the right and left organs. The G30 group pigs' left kidneys had lower weight, volume, and cortical-medullar ratio and 24.6% less glomeruli compared to the right kidney. A negative correlation was found between warm ischemia time and glomerular number. Conclusions: About one quarter of glomeruli was lost after 30 minutes of renal warm ischemia. No glomeruli loss was detected before 20 minutes of warm ischemia. However, progressive glomerular loss was associated with increasing warm ischemia time.

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Section: ■ Discussionmentioning

confidence: 99%

The relationship between renal warm ischemia time and glomerular loss. An experimental study in a pig model

et al. 2017

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“…Oncologic outcomes for NSS have been reported previously for masses in a solitary kidney with a primary focus on open approach. [10][11][12] Berczi et al reported a five-year disease specific survival rate of 93% in their cohort of patients undergoing either LPN or OPN. 10 La Rochelle and partners reported a similar 89% five-year disease-specific survival rate.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12] Berczi et al reported a five-year disease specific survival rate of 93% in their cohort of patients undergoing either LPN or OPN. 10 La Rochelle and partners reported a similar 89% five-year disease-specific survival rate. 11 Additionally, Lee et al described an 83.1% five-year disease-specific survival rate.…”

Section: Discussionmentioning

confidence: 99%

Robotic and open partial nephrectomy for tumors in a solitary kidney

Abedali

Monn

Cleveland

et al. 2020

Journal of Clinical Urology

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Introduction and objective: Traditionally, patients with renal masses in solitary kidneys were managed with an open partial nephrectomy. With improving techniques, robotic-assisted partial nephrectomy in the setting of a solitary kidney is increasingly utilized. The objective of this study was to compare open partial nephrectomy and robotic-assisted partial nephrectomy outcomes in solitary kidney patients. Methods: A retrospective study of 536 total patients who underwent partial nephrectomy between 2004–2016 was performed. Of these patients, 23 had a renal mass in a solitary kidney. Patient demographics, perioperative values, and surgical outcomes were analyzed using descriptive statistics to compare open partial nephrectomy to robotic-assisted partial nephrectomy. Results: Of the 23 patients in the cohort, 52% ( n=12) underwent open partial nephrectomy and 48% ( n=11) underwent robotic-assisted partial nephrectomy. Patient characteristics were not significantly different. The mean (standard deviation) nephrometry score was 6.9 (1.8) for open partial nephrectomy and 6.1 (1.9) for robotic-assisted partial nephrectomy ( p=0.290). The mean (standard deviation) pre-operative creatinine was 1.2 (0.3) in open partial nephrectomy and 1.5 (0.4) in robotic-assisted partial nephrectomy, which did not reach statistical significance ( p=0.110). No difference in postoperative kidney function, Clavien grade 3 or higher complication rate, blood loss, or hospitalization length was noted. Conclusion: Although traditionally patients with a tumor in a solitary kidney are counseled to undergo open partial nephrectomy, robotic-assisted partial nephrectomy is a safe alternative with no decrease in postoperative renal function when compared with a similar cohort of patients undergoing open partial nephrectomy in a solitary kidney. Level of evidence: Level II

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“…Despite great efforts to avoid warm ischemia during partial nephrectomy, with off-clamp and cold ischemia techniques (4, 5), warm ischemia is still necessary during most nephron sparing surgeries (1,2,6), and its harmful and permanent consequences for renal function and the morphology of the remaining parenchyma (7,8) are caused by the high production of reactive oxygen species and consequent lipid peroxidation (25,26). Given this, the use of antioxidant drugs as possible nephron protectors is plausible (9)(10)(11)(18)(19)(20) as well as in other organs and tissues (12-17) associated with ischemia/reperfusion (9,10,(15)(16)(17)(18)(19)(20)26).…”

Section: Discussionmentioning

confidence: 99%

Quercetin as a nephroprotector after warm ischemia: histomorphometric evaluation in a rodent model

et al. 2021

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Purpose: To quantitatively evaluate the possible long-term protective effects of quercetin during renal warm ischemia. Materials and Methods: Male rats were allocated into 4 groups: sham (S), sham quercetin (SQ), ischemia (I), and ischemia quercetin (IQ). Groups SQ and IQ received quercetin (50mg/kg) before and after surgery. Groups I and IQ had their left renal vessels clamped for 60 minutes. All animals were euthanized four weeks after the procedure, and serum urea and creatinine levels were measured. Renal weight and volume, cortex-non-cortex area ratio (C-NC), cortical volume (CV), glomerular volumetric density (Vv[glom]), volume-weighted glomerular volume (VWGV) and number of glomeruli per kidney (N[glom]) were evaluated by stereological methods. Results were considered statistically signifi cant when p <0.05. Results: Serum urea levels in group I increased by 10.4% in relation to group S, but no differences were observed among the other groups. The C-NC of group I was lower than those of all other groups, and group IQ had similar results to sham groups. The Vv [glom] and N[glom] of group I were lower than those of group S (33.7% and 28.3%, respectively) and group IQ had no signifi cant difference compared to the S group. Conclusions: Quercetin was effective as a nephroprotective agent in preventing the glomerular loss observed when the kidney was subjected to warm ischemia. This suggests that this fl avonoid may be used preventively in kidney surgery, when warm ischemia is necessary, such as partial nephrectomy.

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Long-Term Oncological and Functional Outcomes of Partial Nephrectomy in Solitary Kidneys

Cited by 9 publications

References 9 publications

The relationship between renal warm ischemia time and glomerular loss. An experimental study in a pig model

The relationship between renal warm ischemia time and glomerular loss. An experimental study in a pig model

Robotic and open partial nephrectomy for tumors in a solitary kidney

Quercetin as a nephroprotector after warm ischemia: histomorphometric evaluation in a rodent model

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