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

2017 ◽  
Vol 11 (10) ◽  
pp. 344-9 ◽  
Author(s):  
Ernest Chan ◽  
Shawna L. Boyle ◽  
Jeffrey Campbell ◽  
Patrick P.W. Luke
Keyword(s):  
Renal Function ◽  
Minimally Invasive ◽  
Partial Nephrectomy ◽  
Renal Parenchyma ◽  
Renal Masses ◽  
Ischemic Time ◽  
Warm Ischemic Time ◽  
Nephrometry Score ◽  
Function Preservation ◽  
Collecting System

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.

scholarly journals Warm ischemic time’ and renal function preservation in robotic partial nephrectomy -evaluating its real impact

2020 ◽  
Vol 8 (6) ◽  
pp. 161-166
Author(s):  
Krishnendu Biswas ◽  
Rohan S Batra ◽  
Abhishek G Singh ◽  
Arvind P Ganpule ◽  
Ravindra B Sabnis ◽  
...  
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Tumour Size ◽  
Robotic Partial Nephrectomy ◽  
Ischemic Time ◽  
Warm Ischemic Time ◽  
Nephrometry Score ◽  
Significant Difference ◽  
One Year

Objective: To evaluate the effect of warm ischemic time (WIT) on future renal function (RF) after robotic partial nephrectomy (RPN) and secondarily, also to find out predictors of future RF after RPN. Method and materials: All patients who underwent RPN with normal pre-operative RF and normal contralateral kidney were included in the study except for those in whom one-year follow up was not completed. Patients were divided in four groups based on WIT (zero, <20minutes, 20 minutes to 30 minutes and >30 minutes). Comparison of demographic and perioperative parameters including follow-up up to one year were done. Univariable and multivariable analysis were done to detect significant correlation of RF with those parameters. Results: Total 198 RPN patients were included in the study. The four groups had comparable demographic data (age, gender, comorbidity, smoking, body mass index, pre-operative RF). Progressively increased WIT was significantly associated with increased tumour size (p=0.022), RENAL nephrometry score (p=0.003), operative time (p=0.004) and blood loss (p=0.046). Post-operatively, RF on first post-operative day (p=0.627), at one month (p=0.581) and at one year (p=0.378) had no significant difference between the four groups. Nine (4.5%) patients progressed to chronic renal disease. Pre-operative RF and perioperative complications only had significant correlation with one-year RF. Conclusion: Tumour size and RENAL nephrometry score significantly influenced WIT. Pre-operative RF and peri-operative complications were the only significant predictors of future RF and not the WIT.

875: The Effect of Warm Ischemic Time on the Ipsilateral Renal Function after Laparoscopic Partial Nephrectomy

2006 ◽  
Vol 175 (4S) ◽  
pp. 282-283
Author(s):  
Shigeta Masanobu ◽  
Koji Mita ◽  
Tsuguru Usui ◽  
Kazushi Marukawa ◽  
Toshihiro Tachikake
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Laparoscopic Partial Nephrectomy ◽  
Ischemic Time ◽  
Warm Ischemic Time

Renal nephrometry score and predictors of complications in partial nephrectomies.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 512-512
Author(s):  
Deepak K. Pruthi ◽  
Darrel E Drachenberg ◽  
Thomas B McGregor
Keyword(s):  
Partial Nephrectomy ◽  
Univariate Analysis ◽  
Laparoscopic Approach ◽  
Patient Characteristics ◽  
Clinic Visit ◽  
Morbidly Obese ◽  
Complication Rates ◽  
Renal Masses ◽  
Ischemic Time ◽  
Nephrometry Score

512 Background: Feasibility of partial nephrectomy for small renal masses extends beyond standard clinical tumor size. We analyze patient characteristics and anatomic tumor factors to determine variables associated with surgical complications after partial nephrectomy. Methods: Retrospective review of all patients who underwent partial nephrectomy at our institution between January 1, 2012 and Aug 31, 2013. Follow-up extended to 8 week post-operative outpatient clinic visit. The R.E.N.AL. Nephrometry score is a tumor descriptive (the maximum radius, exophytic/endophytic, nearness to collecting system/sinus, anterior/posterior position, location relative to polar line) that was applied to each pre-operative scan. Standardized grading systems and statistical analysis were applied. Results: Of the 83 patients who underwent partial nephrectomy 72 had a laparoscopic approach. Seventeen (20%) patients had complications and seven were Clavien-Dindo grade 3 to 4. Two patients had laparoscopic partial nephrectomies converted intra-operatively to radical nephrectomies; two other laparoscopic partial nephrectomies were converted to open partial nephrectomies. Forty-three (52%) of operated patients were either obese, morbidly obese, or super obese. Fifteen (18%) of patients had pathologic oncocytomas or angiomyelipomas. In univariate analysis Charlson comorbidity score (>6 p=0.0027), diabetes (42% p=0.0195), age (>70 p=0.02034), and total R.E.N.A.L. Nephrometry score (10-12, 67%, p=0.0254) were associated with complications. Nephrometry score also correlated with warm ischemic time (WIT) in laparoscopic cases (low 26 min [SD +/- 11.71], intermediate 31 min [SD +/- 7], high 34 min [SD +/- 14]). Conclusions: Categorizing renal masses according to the R.E.N.A.L. Nephrometry score may help us council patients towards expected WITs, complication rates, and predicted renal function outcomes. This is increasingly important as the majority of our patients are either obese, elderly, or have significant comorbidities; all of which have been shown to be associated with increased complication rates.

scholarly journals Prediction of complications after partial nephrectomy by RENAL nephrometry score

2014 ◽  
Vol 96 (6) ◽  
pp. 475-479 ◽  
Author(s):  
UD Reddy ◽  
R Pillai ◽  
RA Parker ◽  
J Weston ◽  
NA Burgess ◽  
...  
Keyword(s):  
Renal Function ◽  
Postoperative Complications ◽  
Partial Nephrectomy ◽  
Rank Correlation ◽  
Predictive Ability ◽  
Renal Masses ◽  
Explanatory Variables ◽  
Nephrometry Score ◽  
Kendall Rank Correlation ◽  
Prediction Of Complications

Introduction Discussing and planning the appropriate management for suspicious renal masses can be challenging. With the development of nephrometry scoring methods, we aimed to evaluate the ability of the RENAL nephrometry score to predict both the incidence of postoperative complications and the change in renal function after a partial nephrectomy. Methods This was a retrospective study including 128 consecutive patients who underwent a partial nephrectomy (open and laparoscopic) for renal lesions in a tertiary UK referral centre. Univariate and multivariate ordinal regression models were used to identify associations between Clavien–Dindo classification and explanatory variables. The Kendall rank correlation coefficient was used to examine an association between RENAL nephrometry score and a drop in estimated glomerular filtration rate (eGFR) following surgery. Results An increase in the RENAL nephrometry score of one point resulted in greater odds of being in a higher Clavien–Dindo classification after controlling for RENAL suffix and type of surgical procedure (odds ratio [OR]: 1.29, 95% confidence interval [CI]: 1.04–1.64, p=0.043). Furthermore, a patient with the RENAL suffix ‘p’ (ie posterior location of tumour) had increased odds of developing more serious complications (OR: 2.60, 95% CI: 1.07–6.30, p=0.042). A correlation was shown between RENAL nephrometry score and postoperative drop in eGFR (Kendall’s tau coefficient -0.24, p=0.004). Conclusions To our knowledge, this is the first study that has shown the predictive ability of the RENAL nephrometry scoring system in a UK cohort both in terms of postoperative complications and change in renal function.

Factors affecting renal function preservation among patients not achieving trifecta after laparoscopic partial nephrectomy for clinical T1a renal masses

2019 ◽  
Vol 13 (4) ◽  
pp. 526-531
Author(s):  
Toshikazu Takeda ◽  
Akari Komatsuda ◽  
Yoshinori Yanai ◽  
Nobuyuki Tanaka ◽  
Kazuhiro Matsumoto ◽  
...  
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Laparoscopic Partial Nephrectomy ◽  
Renal Masses ◽  
Factors Affecting ◽  
Function Preservation

scholarly journals Non-neoplastic pathologic findings in nephrectomy specimens; postoperative renal insufficiency and outcomes

2019 ◽  
Vol 9 (1) ◽  
pp. 01-01
Author(s):  
Nathan M Shaw ◽  
Frank C. Hill ◽  
Lauren Bakios ◽  
Jayashree Krishnan ◽  
Krishnan Venkatesan ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Insufficiency ◽  
Partial Nephrectomy ◽  
Univariate Analysis ◽  
Renal Parenchyma ◽  
Tubular Atrophy ◽  
Renal Masses ◽  
Vascular Abnormalities ◽  
Institutional Review ◽  
Nephron Sparing

Introduction: Incidence of renal masses has increased with increased abdominal imagings. The trend in treatment of renal masses has been toward renal preserving options, including surveillance, ablation and partial nephrectomy. Objectives: To determine the frequency of medical renal disease in patients undergoing surgical intervention for renal neoplasms and to establish whether these pathologic changes predict development of renal insufficiency in the immediate postoperative period. Patients and Methods: This was an Institutional Review Board (IRB)-approved retrospective review of all patients that underwent radical nephrectomy (RN), partial nephrectomy and nephroureterectomy from December 2009 to November 2013. Around 225 patients had complete pathologic and perioperative data for analysis. We compared preoperative and postoperative glomerular filtration rate (GFR), neoplastic findings, tumor characteristics (positive margins and extracapsular extension), and pathology information regarding non- neoplastic findings (tubular atrophy, chronic inflammation and fibrosis). Results: The presence of any pathologic abnormalities in the non-neoplastic renal parenchyma was significantly associated with increased serum creatinine levels postoperatively (P=0.01) and at last follow up visit (P=0.04). Univariate analysis showed that glomerular and vascular abnormalities were each significantly associated with worsening renal function. Conclusion: Our research suggests that abnormalities in non-neoplastic renal parenchyma found in renal specimens after RN should not be ignored as they may predict possible worse outcomes in renal function. This may help make a case for biopsy pre-operatively and a stronger case for nephron sparing surgery. This may also help determine which patients should be followed more closely postoperatively.

scholarly journals Association between R.E.N.A.L nephrometry score and perioperative outcomes following open partial nephrectomy under cold ischemia

2014 ◽  
Vol 8 (3-4) ◽  
pp. 137
Author(s):  
Dong Soo Park ◽  
Jin Ho Hwang ◽  
Moon Hyung Kang ◽  
Jong Jin Oh
Keyword(s):  
Blood Loss ◽  
Partial Nephrectomy ◽  
Perioperative Outcomes ◽  
Renal Neoplasm ◽  
Cold Ischemia ◽  
Ischemic Time ◽  
Open Partial Nephrectomy ◽  
Cold Ischemic Time ◽  
Nephrometry Score ◽  
Estimated Blood Loss

Introduction: We investigate the clinical significance of the R.E.N.A.L. nephrometry score for renal neoplasm following open partial nephrectomy (PN) under cold ischemia.Methods: A retrospective analysis was conducted using clinical data of 98 consecutive patients with clear cell renal cell carcinoma who underwent open PN by a single surgeon from December 2000 to September 2012. Tumour complexity was stratified into 3 categories: low (4-6), moderate (7-9) and high (10-12) complexity. Perioperative outcomes, such as complications, cold ischemic time, estimated blood loss and renal function, were analyzed according to the complexity by NS. Complications were stratified using the Clavien-Dindo classification system.Results: Tumour complexity according to nephrometry score was assessed as low in 16 (16.3%), moderate in 48 (49.0%) and high in 34 (34.7%). The median cold ischemic time did not differ significantly among the 3 groups (36.0 minutes in low-, 40 minutes in moderate- and 43 minutes in the high-complexity group, p = 0.421). Total complications did not differ significantly (2 (2.0%) in low, 4 (4.1%) in moderate and 4 (4.1%) in high, p = 0.984). Each Grade 3 complication occurred in the moderate (urine leakage) and high groups (lymphocele). Postoperative renal functional outcomes were similar among the groups (p = 0.729). Only mean estimated blood loss was significantly different with nephrometry score (p = 0.049).Conclusions: The nephrometry score, as used in an open PN series under cold ischemia, was not significantly associated with perioperative outcomes (i.e., ischemia time, complications, renal functional preservation).

Sign in / Sign up

Export Citation Format

Share Document