Residual Parenchymal Volume, Not Warm Ischemia Time, Predicts Ultimate Renal Functional Outcomes in Patients Undergoing Partial Nephrectomy

Ginzburg, Serge; Uzzo, Robert G.; Walton, J.T.; Miller, Christopher; Kurz, David J.; Li, Tianyu; Handorf, Elizabeth; Gor, Ronak A.; Corcoran, Anthony; Viterbo, Rosalia; Chen, David Y.T.; Greenberg, Richard E.; Smaldone, Marc C.; Kutikov, Alexander

doi:10.1016/j.urology.2015.04.043

Cited by 61 publications

(34 citation statements)

References 17 publications

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“…In a retrospective study of 362 patients with a solitary kidney, a WIT of > 25 min was reported as an independent predictor of reduced long-term renal function [16]. In contrast, Ginzburg et al [17] confirmed that WIT had an adverse relationship with perioperative outcome alone, and not with long-term renal function (duration, 6.4 months). Furthermore, Shah et al [18] demonstrated that there were no differences in renal function reduction after LPN between on-clamp (mean WIT, 26 min) and off-clamp patients in follow-up beyond 6 months for up to 5 years.…”

Section: Resultsmentioning

confidence: 97%

Early Unclamping Laparoscopic Partial Nephrectomy for Complex Renal Tumor: Data from a Chinese Cohort

Zhang

Zhao

et al. 2019

Urol Int

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Objective: To evaluate the efficacy and safety of early unclamping laparoscopic partial nephrectomy (LPN) for complex renal tumor relative to the standard artery clamping technique (SCT). Methods: Sixty-one patients with complex renal tumor (RENAL score ≥7) underwent LPN at our institution from January 2013 to April 2017. LPN was performed via SCT in 32 patients and via the early unclamping technique (EUT) in 29 patients. Operation time, warm ischemia time (WIT), blood loss, bleeding requiring transfusion, tumor volume, excisional volume loss (EVL), complications, and renal function before and after operation of the affected kidney were compared between the groups. Results: All surgeries were successful without conversion to open or nephrectomy. EUT reduced the WIT (p < 0.001) but did not increase the complication rate (p = 0.322). Although the tumor volume and EVL were larger in the EUT than in the SCT group (p = 0.011, p = 0.001), glomerular filtration rate (GFR) reduction in the affected kidney did not significantly differ between the groups (p = 0.120). Conclusion: Early unclamping LPN for complex renal tumor is safe and efficient. Additionally, the EUT could expand the application of LPN in complex renal tumors, and make this challenging surgery easier and safer.

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Section: Resultsmentioning

confidence: 97%

Early Unclamping Laparoscopic Partial Nephrectomy for Complex Renal Tumor: Data from a Chinese Cohort

Zhang

Zhao

et al. 2019

Urol Int

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“…In patients with normal preoperative kidney function, who have WIT within acceptable limits, RPV has been suggested as the primary determinant of long-term functional outcome after PN 12 . Recently, several studies showed that having no functional residual renal volume and postoperative renal recovery can also affect postoperative renal functional outcome which was difficult to have precise prediction before surgery 13–15 .…”

Section: Discussionmentioning

confidence: 99%

Peritumoral Artery Scoring System: a Novel Scoring System to Predict Renal Function Outcome after Laparoscopic Partial Nephrectomy

Zhang

Huang

et al. 2017

Sci Rep

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The present study aimed to assess the impact of peritumoral artery characteristics on renal function outcome prediction using a novel Peritumoral Artery Scoring System based on computed tomography arteriography. Peritumoral artery characteristics and renal function were evaluated in 220 patients who underwent laparoscopic partial nephrectomy and then validate in 51 patients with split and total glomerular filtration rate (GFR). In particular, peritumoral artery classification and diameter were measured to assign arteries into low, moderate, and high Peritumoral Artery Scoring System risk categories. Univariable and multivariable logistic regression analyses were then used to determine risk factors for major renal functional decline. The Peritumoral Artery Scoring System and four other nephrometry systems were compared using receiver operating characteristic curve analysis. The Peritumoral Artery Scoring System was significantly superior to the other systems for predicting postoperative renal function decline (p < 0.001). In receiver operating characteristic analysis, our category system was a superior independent predictor of estimated glomerular filtration rate (eGFR) decline (area-under-the-curve = 0.865, p < 0.001) and total GFR decline (area-under-the-curve = 0.796, p < 0.001), and split GFR decline (area-under-the-curve = 0.841, p < 0.001). Peritumoral artery characteristics were independent predictors of renal function outcome after laparoscopic partial nephrectomy.

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“…Ginzburg et al. affirmed that renal function at ~6 months after PN does not appear to correlate with intraoperative WIT and is primarily associated with parenchymal volume preservation. Although the duration of ischaemia has historically been used as a surrogate for renal functional outcomes after PN, recent studies have found that sparing renal parenchyma after PN assumes a more important role in predicting future renal function .…”

Section: Discussionmentioning

confidence: 99%

“…Parekh et al [15] reported that variations of ischaemic durations from 15 to 61 min had no functional and structural effect on the injury produced after PN. Ginzburg et al [16] affirmed that renal function at Schematic illustration of the predictive study design for analysing the correlation between PRF decline and the RAIV. The preoperatively calculated RAIV could be a surrogate for the VNL after PN.…”

Section: Discussionmentioning

confidence: 99%

Impact of preoperative calculation of nephron volume loss on future of partial nephrectomy techniques; planning a strategic roadmap for improving functional preservation and securing oncological safety

et al. 2017

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Residual Parenchymal Volume, Not Warm Ischemia Time, Predicts Ultimate Renal Functional Outcomes in Patients Undergoing Partial Nephrectomy

Cited by 61 publications

References 17 publications

Early Unclamping Laparoscopic Partial Nephrectomy for Complex Renal Tumor: Data from a Chinese Cohort

Early Unclamping Laparoscopic Partial Nephrectomy for Complex Renal Tumor: Data from a Chinese Cohort

Peritumoral Artery Scoring System: a Novel Scoring System to Predict Renal Function Outcome after Laparoscopic Partial Nephrectomy

Impact of preoperative calculation of nephron volume loss on future of partial nephrectomy techniques; planning a strategic roadmap for improving functional preservation and securing oncological safety

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