Ipsilateral renal function preservation following minimally invasive partial nephrectomy

The effect of tumour characteristics and warm ischemic time

Ernest Chan, Shawna L Boyle, Jeffrey Campbell, Patrick P.W. Luke

Research output: Contribution to journalArticle

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Abstract

Introduction: The relative impact of preoperative and perioperative variables on renal function following partial nephrectomy (PN) is controversial. To further investigate, we assess the effects of tumour complexity, warm ischemic time (WIT), and volume of resected renal parenchyma on ipsilateral renal function (IRF) outcomes following minimally invasive PN. Methods: Of patients who underwent laparoscopic or roboticassisted PN between 2002 and 2011 at our institution, 99 met our inclusion criteria. The effects of preoperative tumour complexity (using RENAL nephrometry score), perioperative WIT, and pathological tumour volumes on ipsilateral renal function preservation (%IRF) were analyzed. %IRF was defined as the proportion of postoperative to preoperative ipsilateral renal function calculated using MAG3 nuclear renography. Results: Increasing RENAL nephrometry score (RNS) and WIT were independently predictive of inferior %IRF at 6?12-week postoperative followup in univariate and multivariate analyses. Of RNS properties, masses that were endophytic, near the collecting system, or central in location were associated with inferior %IRF, with nearness to collecting system as the strongest predictor; however, RNS was no longer predictive of %IRF in cases requiring more than 30 minutes of WIT. Conclusions: In renal masses amenable to resection by minimally invasive PN, longer WIT was the most important predictor of inferior %IRF. Although increasing RNS score influenced %IRF, the overall clinical significance of RNS is limited and should not influence operative decision-making in efforts to preserve renal function. Furthermore, small volumes of renal parenchyma can be safely resected without impairment of long-term IRF.

Original languageEnglish (US)
Pages (from-to)344-349
Number of pages6
JournalCanadian Urological Association Journal
Volume11
Issue number10
DOIs
StatePublished - Oct 1 2017
Externally publishedYes

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Warm Ischemia
Nephrectomy
Kidney
Neoplasms
Radioisotope Renography
Tumor Burden

ASJC Scopus subject areas

  • Urology

Cite this

Ipsilateral renal function preservation following minimally invasive partial nephrectomy : The effect of tumour characteristics and warm ischemic time. / Chan, Ernest; Boyle, Shawna L; Campbell, Jeffrey; Luke, Patrick P.W.

In: Canadian Urological Association Journal, Vol. 11, No. 10, 01.10.2017, p. 344-349.

Research output: Contribution to journalArticle

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