Open partial nephrectomy in renal cell cancer – Essential or obsolete?

Anastasiadis, Eleni; O'Brien, Timothy; Fernando, A.

doi:10.1016/j.ijsu.2016.05.031

Cited by 13 publications

(16 citation statements)

References 37 publications

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“…The variables studied included patients' demographics such as age, gender, weight, height, body mass index (BMI), co-morbid medical condition(s) such as diabetes mellitus (DM) and hypertension (HTN), American society of anesthesiologist (ASA) score, tumor characteristics like tumor size and location, laterality, R.E.N.A.L nephrometry score 8 {comprising of Radius (tumor size and maximum dimension), Exophytic or endophytic nature, Nearness of tumor to collecting system, Anterior or posterior and Location relative to polar lines}, intra-operative data such as overall operative time, warm ischemia time, estimated blood loss and transfusion rate, postoperative outcomes such as length of hospital stay, tumor histology, surgical margins, Fuhrman's nuclear grade and 30-days post-operative complications measured by modified Claviandindo classification. Patients' renal function i.e.…”

Section: Methodsmentioning

confidence: 99%

“…Imran Khan Jalbani et al nephrectomy still retains its role for the treatment of renal tumor with the largest worldwide clinical experience and considered as reference gold standard for PN by American urological association guidelines. 8 The aim of PN is not only cancer control but maximum renal functional preservation as well.…”

Section: Despite Introduction Of Minimally Invasive Surgery Over the Last Two Decades Open Partialmentioning

confidence: 99%

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Nephron sparing surgery for renal tumors-comparison of off-clamp partial nephrectomy with hilar clamping

et al. 2020

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Background and Objective: Open partial nephrectomy (PN) is still considered gold standard procedure for T1 localized renal tumors. Conventional technique involves clamping of the renal artery with or without vein however, renal ischemia produces a certain level of damage to the kidneys. This study aims to investigate potential effect of off-clamp vs. hilar clamping PN on renal function. Methods: This is a retrospective cohort study of patients who underwent unilateral, open partial nephrectomy for renal tumors b/w January 2009 December 2016 at our institution. A total of 90 partial nephrectomies were performed of which 65 cases were eligible for analysis. Non clamping technique was used in 43 while clamp was applied in 22 patients. Variables studied were patients’ demographics, clinical variables, the laterality, tumors size and location, R.E.N.A.L nephrometry score, blood loss, tumor histology and surgical margins. Patients’ renal function (serum creatinine and eGFR) were determined pre-operatively, at 3 and 12 months follow up. Data was analyzed on SPSS v. 22. Results: Both the groups were comparable with regards to pre-operative renal function. Mean radiological size of tumor was 4.71±1.31 and 3.81±1.0 (0.003) in two groups respectively. Mean R.E.N.A.L nephrometry score was 6.1±1.5 in off-clamp group compared to 7.05±1.7 in clamp group (p=0.04). No statistically significant difference was found in operative duration, blood loss, positive surgical margins and intra/ peri-operative complications. At three months and one year, renal function was better preserved in non-clamp group compared to clamp group (p=0.001 and 0.007 respectively). Conclusion: Off clamp open partial nephrectomy is safe and feasible option leading to less decline in renal function. doi: https://doi.org/10.12669/pjms.36.3.1533 How to cite this:Jalbani IK, Nazim SM, Ahmed M, Abbas F. Nephron sparing surgery for renal tumors- comparison of off-clamp partial nephrectomy with hilar clamping. Pak J Med Sci. 2020;36(3):---------. doi: https://doi.org/10.12669/pjms.36.3.1533 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Section: Methodsmentioning

confidence: 99%

Section: Despite Introduction Of Minimally Invasive Surgery Over the Last Two Decades Open Partialmentioning

confidence: 99%

Nephron sparing surgery for renal tumors-comparison of off-clamp partial nephrectomy with hilar clamping

et al. 2020

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“…The role of OPN has evolved to permit treatment of increasingly complex tumors, enabling surgeons to push the boundaries of nephron-sparing surgery. [ 10 ] Cooling the kidney surface with slushed ice during hilar clamping is a traditional and important technique during OPN to preserve renal function. [ 11 ] This offers a great advantage in allowing extended ischemic time compared with minimally invasive approaches such as laparoscopic surgery and robot-assisted laparoscopic surgery with warm renal ischemia.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of open partial nephrectomy for renal cell carcinoma in the minimally invasive approach era

Shibamori¹,

Hashimoto²,

Shindo³

et al. 2021

Current Urology

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Background: We investigated the characteristics and outcomes of patients who underwent open partial nephrectomy (OPN) in the minimally invasive approach era. Materials and methods: We retrospectively reviewed 52 patients (55 cases) who underwent OPN from May 2009 to March 2016. We assessed perioperative change in estimated glomerular filtration rate (eGFR), complications, and oncological outcomes. Tumor complexity was evaluated using the R.E.N.A.L nephrometry score (NS) and the modified NS. Results: Fifteen cases (27%) had imperative indications and 40 (73%) had elective indications. The elective cases were more likely to have adverse tumor complexity based on NS. The perioperative complication rate defined as a Clavien-Dindo grade ≥IIIa was 11%. The rate of postoperative decline in eGFR at 1 month, 1 year, and 2 years was 22%, 20%, and 21%, respectively. Multivariate analysis revealed that male gender (odds ratio [OR] 11.8, p = 0.03), NS ≥9 (OR 13.9, p = 0.02), modified NS ≥11 (OR 13.5, p = 0.01), and cold ischemic time ≥40 minutes (OR 7.9, p = 0.04) were significantly associated with worsening eGFR at 1 year after surgery. During a median follow-up period of 52 months, the 5-year overall survival and recurrence-free survival rates were 93% and 84%, respectively. Conclusions: OPN is acceptable with regard to oncological outcomes and complications in the minimally invasive surgery era. We propose that OPN should be the preferred approach in cases in which it is technically difficult to preserve maximum renal function via a minimally invasive approach.

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“…It also allows ice cooling of the kidney in patients with impaired renal function. The indications, technique and considerations are detailed in the special series paper by Anastasiadis et al [12].…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%