Recovery of Renal Function After Open and Laparoscopic Partial Nephrectomy

Adamy, Ari; Favaretto, Ricardo L.; Nogueira, Lucas; Savage, Caroline; Russo, Paul; Coleman, Jonathan; Guillonneau, Bertrand; Touijer, Karim

doi:10.1016/j.eururo.2010.05.044

Cited by 33 publications

(26 citation statements)

References 24 publications

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“…19 The clinical significance of this phenomenon is not well established, particularly at the abdominal pressure of 12–15 mm Hg. 20 Adamy et al 21 compared the renal function outcomes of 987 patients who underwent open versus laparoscopic PN from 2002 to 2009. They found that the surgical approach had only a small effect on the eGFR outcomes and, in fact, slightly favored laparoscopic PN.…”

Section: Commentmentioning

confidence: 99%

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

Power

Maschino

Savage

et al. 2012

Urology

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OBJECTIVE To evaluate intravenous mannitol during minimally invasive partial nephrectomy (PN) by comparing the renal function outcomes of the patients who received it versus those who did not. METHODS Of 285 consecutive elective minimally invasive PN cases from February 2005 to July 2010, 164 patients (58%) were treated with mannitol. We compared the renal function recovery using a multivariate generalized estimating equation linear model of estimated glomerular filtration rate (eGFR) controlling for nephrometry complexity, preoperative eGFR, American Society of Anesthesiologists score, ischemia time, estimated blood loss, age, and sex. Sensitivity analyses were performed to adjust for cold ischemia and individual surgeon differences corrected for year of surgery. RESULTS Of the 285 patients who underwent minimally invasive treatment, 164 received mannitol and 121 did not. Those who received mannitol had a better preoperative eGFR (median 72 vs 69 mL/min/m2, P =.046), less complex nephrometry scores (P =0.051), and were less likely to have an American Society of Anesthesiologists score of ≥3 (42% vs 54%, P =.005). Renal function recovery was similar in both groups (estimated effect of mannitol −0.7 mL/min/m2, 95% confidence interval −3.6-2.2, P =.6). At no point in the postoperative period did mannitol make a significant difference in the eGFR according to the generalized estimating equation model after adjusting for multiple potential renal function confounders. CONCLUSION Mannitol use did not influence renal function recovery within 6 months of minimally invasive PN as measured by the eGFR in our analysis. An appropriately designed prospective study of mannitol is being conducted to validate its use during PN.

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Section: Commentmentioning

confidence: 99%

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

Power

Maschino

Savage

et al. 2012

Urology

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“…Adamy et al [18] reported that renal function 6 months post-LPN was slightly increased compared with postoperative 2 months and was then maintained at a constant level. Our study also showed that the renal function at 3 months post-LPN was slightly increased compared with postoperative 1 month and was then maintained at a constant increased state up to postoperative 1 year.…”

Section: Discussionmentioning

confidence: 99%

Changes in Renal Function After Laparoscopic Partial Nephrectomy: Comparison With Laparoscopic Radical Nephrectomy

2013

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PurposeTo evaluate alterations in renal function after laparoscopic radical nephrectomy (LRN) and laparoscopic partial nephrectomy (LPN) for renal tumors.Materials and MethodsFrom March 2008 to August 2011, we performed 175 cases of laparoscopic kidney resection. Among these, we excluded patients who received perioperative immunotherapy or target therapy and also patients with a preoperative estimated glomerular filtration rate (eGFR) <60 mL/min. A total of 32 patients undergoing LPN and 92 patients undergoing LRN were enrolled. We retrospectively reviewed the changes in eGFR (by the modification of diet in renal disease method) at the following time points: preoperative, postoperative 1 week, and postoperative 1, 3, 6, and 12 months.ResultsThe mean warm ischemia time of the LPN group was 22 minutes (range, 0 to 47 minutes). Mean eGFR values (mL/min/1.73 m2) during postoperative week 1 and 1, 3, 6, and 12 months were 70.8, 71.5, 76.7, 76.0, and 75.3 in the LPN group and 52.1, 50.6, 52.8, 53.4, and 52.4 in the LRN group, respectively. One year after the operation, 6.3% (2 patients) of LPN patients and 68.5% (63 patients) of LRN patients had progressed to chronic renal insufficiency (eGFR<60 mL/min/1.73 m2).ConclusionsRenal function recovered slightly after LPN and LRN and was maintained constantly after 3 months. However, renal function showed different patterns of decrease. Despite the concern for warm ischemia, LPN can preserve renal function better than can LRN. LPN should be considered for selected patients to prevent chronic renal insufficiency.

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“…Therefore, we hypothesized that the damage to renal function in LPN was more severe than that in OPN. Adamy et al (15) compared renal function at 2 and 6 POM after 805 OPNs and 182 LPNs, and concluded that the difference in the surgical approach had only a small effect on renal function. A similar result was obtained in the present study.…”

Section: Discussionmentioning

confidence: 99%

The Benefit of Laparoscopic Partial Nephrectomy in High Body Mass Index Patients

Kaneko

Miyajima

Kikuchi

et al. 2012

Japanese Journal of Clinical Oncology

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Objective: The aims of the present study were to evaluate the effect of body mass index on the surgical outcomes of open partial nephrectomy and laparoscopic partial nephrectomy, and to analyze whether higher body mass index patients may derive greater benefit from laparoscopic partial nephrectomy. Methods: We reviewed 110 patients who underwent open partial nephrectomy and 47 patients who underwent laparoscopic partial nephrectomy at our institution. We analyzed the data to determine what kind of factor would be associated with prolonged operative time, increased estimated blood loss and prolonged ischemic time, and compared the result of open partial nephrectomy with that of laparoscopic partial nephrectomy. Results: A statistically significant correlation was observed between body mass index and operative time or estimated blood loss in open partial nephrectomy. Multivariate analysis also demonstrated that body mass index was an independent predictor for prolonged operative time and higher estimated blood loss in open partial nephrectomy, but not in laparoscopic partial nephrectomy. In the normal body mass index group (body mass index , 25.0 kg/m 2 ), although mean operative time in the laparoscopic partial nephrectomy group was significantly longer than that in the open partial nephrectomy group, the difference was relatively small. In the high body mass index group (body mass index 25.0 kg/m 2 ), the mean operative time of the two groups was not statistically different. The estimated blood loss of open partial nephrectomy was significantly higher than that of laparoscopic partial nephrectomy in both groups. In both operative procedures, tumor size was an independent predictor for prolonged ischemic time in multivariate analysis. Conclusions: Body mass index was an independent predictor for prolonged operative time and higher estimated blood loss in open partial nephrectomy but not in laparoscopic partial nephrectomy. Laparoscopic partial nephrectomy was less influenced by body mass index and had a greater benefit, especially in high body mass index patients.

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Recovery of Renal Function After Open and Laparoscopic Partial Nephrectomy

Cited by 33 publications

References 24 publications

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

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

Changes in Renal Function After Laparoscopic Partial Nephrectomy: Comparison With Laparoscopic Radical Nephrectomy

The Benefit of Laparoscopic Partial Nephrectomy in High Body Mass Index Patients

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