Renal Ischemia and Function After Partial Nephrectomy: A Collaborative Review of the Literature

Abstract

ContextPartial nephrectomy (PN) is the current gold standard treatment for small localized renal tumors.; however, the impact of duration and type of intraoperative ischemia on renal function (RF) after PN is a subject of significant debate. ObjectiveTo review the current evidence on the relationship of intraoperative ischemia and RF after PN. Evidence acquisitionA review of English-language publications on renal ischemia and RF after PN was performed from 2005 to 2014 using the Medline, Embase, and Web of Science databases. Ninety-one articles were selected with the consensus of all authors and analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Evidence synthesisThe vast majority of reviewed studies were retrospective, nonrandomized observations. Based on the current literature, RF recovery after PN is strongly associated with preoperative RF and the amount of healthy kidney parenchyma preserved. Warm ischemia time (WIT) is modifiable and prolonged warm ischemia is significantly associated with adverse postoperative RF. Available data suggest a benefit of keeping WIT <25 min, although the level of evidence to support this threshold is limited. Cold ischemia safely facilitates longer durations of ischemia. Surgical techniques that minimize or avoid global ischemia may be associated with improved RF outcomes. ConclusionsAlthough RF recovery after PN is strongly associated with quality and quantity of preserved kidney, efforts should be made to limit prolonged WIT. Cold ischemia should be preferred when longer ischemia is expected, especially in presence of imperative indications for PN. Additional research with higher levels of evidence is needed to clarify the optimal use of renal ischemia during PN. Patient summaryIn this review of the literature, we looked at predictors of renal function after surgical resection of renal tumors. There is a strong association between the quality and quantity of renal tissue that is preserved after surgery and long-term renal function. The time of interruption of renal blood flow during surgery is an important, modifiable predictor of postoperative renal function.

Structure of 90 day complications after solitary kidney resection due to parenchyma tumors

“…A. Volpe и соавт. также подчерки-вают важность сохраняемого объема паренхимы по-чки, длительности ишемии и функциональное состо-яние оставшейся части почки [19].…”

Surgical and Minimally Invasive Therapies for the Management of the Small Renal Mass

“…A recent collaborative review of evidence concerning ischaemia in PN concluded that the data suggest a benefit of keeping WIT under 25 minutes [32].…”

“…Cold ischaemia allows safer prolonged ischaemia and should be considered when this is expected, especially in presence of imperative indications for PN [33,32].…”

Ipsilateral renal function preservation following minimally invasive partial nephrectomy: The effect of tumour characteristics and warm ischemic time

“…Although others have assessed the effect of tumour size, RENAL nephrometry score (RNS), and warm ischemic time (WIT) on ipsilateral renal function following PN, the relative impact of these factors has been inconsistent. [8][9][10][11] This is partly due to the use of estimated glomerular filtration rate (eGFR) in evaluation of postoperative renal function; eGFR underestimates ipsilateral renal impairment because compensatory hypertrophy and hyperfiltration occurs in the contralateral renal unit following PN. 12 We investigated the effect of tumour size, piece size, volume of resected renal parenchyma, RNS, and WIT on ipsilateral renal function (IRF) following PN in our centre.…”