Is off‐clamp robotic partial nephrectomy beneficial for renal function? data from the clock trial

2021 ◽  
Author(s):  
Alessandro Antonelli ◽  
Luca Cindolo ◽  
Marco Sandri ◽  
Alessandro Veccia ◽  
Filippo Annino ◽  
...  
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Robotic Partial Nephrectomy ◽  
Function Data

scholarly journals Tumor volume and tumor crossing of the axial renal midline predict renal function after robotic partial nephrectomy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Haruyuki Ohsugi ◽  
Kyojiro Akiyama ◽  
Hisanori Taniguchi ◽  
Masaaki Yanishi ◽  
Motohiko Sugi ◽  
...  
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Tumor Volume ◽  
Characteristic Curve ◽  
Three Dimensional ◽  
Scoring Systems ◽  
Renal Tumors ◽  
Perioperative Outcomes ◽  
Robotic Partial Nephrectomy ◽  
Perioperative Morbidity

AbstractThere are several nephrometry scoring systems for predicting surgical complexity and potential perioperative morbidity. The R.E.N.A.L. scoring system, one of the most well-known nephrometry scoring systems, emphasizes the features on which it is based (Radius, Exophytic/endophytic, Nearness to collecting system or sinus, Anterior/posterior, and Location relative to polar lines). The ability of these nephrometry scoring systems to predict loss of renal function after robotic partial nephrectomy (RPN) remains controversial. Therefore, we verified which combination of factors from nephrometry scoring systems, including tumor volume, was the most significant predictor of postoperative renal function. Patients who underwent RPN for cT1 renal tumors in our hospital were reviewed retrospectively (n = 163). The preoperative clinical data (estimated glomerular filtration rate [eGFR], comorbidities, and nephrometry scoring systems including R.E.N.A.L.) and perioperative outcomes were evaluated. We also calculated the tumor volume using the equation applied to an ellipsoid by three-dimensional computed tomography. The primary outcome was reduced eGFR, which was defined as an eGFR reduction of ≥ 20% from baseline to 6 months after RPN. Multivariable logistic regression analyses were used to evaluate the relationships between preoperative variables and reduced eGFR. Of 163 patients, 24 (14.7%) had reduced eGFR. Multivariable analyses indicated that tumor volume (cutoff value ≥ 14.11 cm3, indicating a sphere with a diameter ≥ approximately 3 cm) and tumor crossing of the axial renal midline were independent factors associated with a reduced eGFR (odds ratio [OR] 4.57; 95% confidence interval [CI] 1.69–12.30; P = 0.003 and OR 3.50; 95% CI 1.30–9.46; P = 0.034, respectively). Our classification system using these two factors showed a higher area under the receiver operating characteristic curve (AUC) than previous nephrometry scoring systems (AUC = 0.786 vs. 0.653–0.719), and it may provide preoperative information for counseling patients about renal function after RPN.

scholarly journals Optimization of renal function preservation during robotic partial nephrectomy

2019 ◽  
Vol 11 ◽  
pp. 175628721881581 ◽  
Author(s):  
Natalie R. Swavely ◽  
Uzoma A. Anele ◽  
Francesco Porpiglia ◽  
Maria C. Mir ◽  
Lance J. Hampton ◽  
...  
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Patient Characteristics ◽  
Robotic Partial Nephrectomy ◽  
Postoperative Renal Function ◽  
Renal Hilum ◽  
Function Preservation ◽  
Baseline Factors ◽  
Potential Factors ◽  
Robotic Assisted Partial Nephrectomy

Over the past few years, the role of robotic-assisted partial nephrectomy (RPN) has exponentially grown. Multiple recognized factors contribute to postoperative renal function in patients undergoing RPN. The aim of this review is to identify these potential factors, and to evaluate strategies that may help optimize the goal of renal function preservation. A nonsystematic literature review was performed to retrieve the most recent evidence on factors contributing to renal function post-RPN. Analyzed elements include baseline factors (tumor complexity and patient characteristics), intraoperative (surgical) factors (control of the renal hilum and type of ischemia, resection technique, renorrhaphy technique), and pharmacotherapeutics. In conclusion, the advantages of robotic surgery in the setting of partial nephrectomy (PN) are becoming well established. Maximal preservation of renal function remains a priority goal of the procedure, and it is influenced by a plethora of factors. Adequate patient selection using radiomics, control of comorbidities, utilization of evidence-based intraoperative techniques/strategies, and postoperative care are key components of postoperative preservation of renal function. Further investigations regarding these factors and their effects on long-term renal function are necessary and will continue to aid in guiding appropriate patient care.

Does teaching of robotic partial nephrectomy affect renal function and perioperative outcomes?

2017 ◽  
Vol 35 (5) ◽  
pp. 227-233 ◽  
Author(s):  
Yannick Cerantola ◽  
Guillaume Ploussard ◽  
Wassim Kassouf ◽  
Maurice Anidjar ◽  
Franck Bladou
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Perioperative Outcomes ◽  
Robotic Partial Nephrectomy

What is the most important predictor of renal function after opened and robotic partial nephrectomy? A propensity score matched study.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 701-701
Author(s):  
Ngoc Ha Nguyen ◽  
Jae Young Joung ◽  
Sangchul Lee ◽  
Hakmin Lee ◽  
Young Dong Yu ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Renal Function ◽  
Propensity Score ◽  
Postoperative Complication ◽  
Partial Nephrectomy ◽  
Robotic Partial Nephrectomy ◽  
Ckd Progression ◽  
Ischemic Time ◽  
Major Postoperative Complication ◽  
Estimated Blood Loss

701 Background: This study was designed to investigate the parameters that predict the short term and long term renal function after opened partial nephrectomy (OPN) and robot-assisted partial nephrectomy (RPN). Methods: Medical records of 896 patients who underwent OPN and RPN between Feb 2004 to Apr 2017 at our institution were retrospectively reviewed. The propensity scores matching between of OPN and RPN group were performed with a ratio of 1:1. Postoperative outcomes were compared and multivariate logistic regression was performed to identify the parameters influencing acute kidney injury (AKI) and chronic kidney disease (CKD) progression. Results: No significant differences of preoperative characteristics were observed between two study groups after propensity score matching. RPN was significantly associated with longer warm ischemic time (WIT) (p < 0.001); yet, estimated blood loss (EBL), positive surgical margin (PSM) rate, major postoperative complication and CKD progression were significantly lower in RPN group (p values were < 0.001; 0.033; < 0.001; < 0.001 and 0.005 respectively). Multivariate analysis exhibited RPN is more favorable than OPN in terms of preserving renal function. Patients with a higher baseline estimated glomerular filtration rate (eGFR) were significantly associated with greater risk of AKI (OR = 1.036; 95% CI of OR 1.021-1.052; p < 0.001), but reduced risk of CKD progression (OR = 0.975; 95% CI of OR 0.955-0.994; p = 0.011). Other independent predictors of CKD progression included WIT (p = 0.025), age (p = 0.035), higher BMI (0.041) and diabetes mellitus history (p = 0.035). Conclusions: Age, BMI, diabetes mellitus history, baseline eGFR and WIT were the independent predictors of CKD progression after PN. RPN is more favorable than OPN for reducing EBL, PSM, major postoperative complication and renal function preservation.

Tumor Volume and Tumor Crossing of the Axial Renal Midline as Preoperative Predictors of Reduced Estimated Glomerular Filtration Rate After Robotic Partial Nephrectomy

2021 ◽  
Author(s):  
Haruyuki Ohsugi ◽  
Kyojiro Akiyama ◽  
Hisanori Taniguchi ◽  
Masaaki Yanishi ◽  
Motohiko Sugi ◽  
...  
Keyword(s):  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Partial Nephrectomy ◽  
Filtration Rate ◽  
Tumor Volume ◽  
Estimated Glomerular Filtration Rate ◽  
Scoring Systems ◽  
Renal Tumors ◽  
Robotic Partial Nephrectomy

Abstract The ability of nephrometry scoring systems, including the radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, and location relative to polar lines (R.E.N.A.L.), to predict loss of renal function after robotic partial nephrectomy (RPN) is still controversial. Therefore, we verified which combination of factors from nephrometry scoring systems, including tumor volume, was the most significant predictor of postoperative renal function. Patients who underwent RPN for cT1 renal tumors in our hospital were reviewed retrospectively (n=163). The preoperative clinical data (estimated glomerular filtration rate [eGFR], comorbidities, and nephrometry scoring systems including R.E.N.A.L.) and perioperative outcomes were evaluated. We also calculated the tumor volume using the equation applied to an ellipsoid by three-dimensional computed tomography. The primary outcome was reduced eGFR, which was defined as an eGFR reduction of ≥20% from baseline to 6 months after RPN. Multivariate logistic regression analyses were used to evaluate the relationships between preoperative variables and reduced eGFR. Of 163 patients, 24 (14.7%) had reduced eGFR. Multivariate analyses indicated that tumor volume (cutoff value≥14.11 cm3, indicating a sphere with a diameter≥approximately 3 cm) and tumor crossing of the axial renal midline were independent factors for reduced eGFR (odds ratio [OR], 4.57; P=0.003 and OR, 3.21; P=0.034, respectively). Our classification system using these two factors showed a higher area under the receiver operating characteristic curve (AUC) than previous nephrometry scoring systems (AUC=0.786 vs. 0.653–0.719), and it may provide preoperative information for counseling patients about renal function after RPN.

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