Category: Laparoscopic/ Robotic: Other

MP16-3 - Effects of warm ischemia time on kidney function after partial nephrectomy

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective :

The decline of the estimated glomerular filtration rate (eGFR) after partial nephrectomy (PN) for small renal masses depends on the length of warm ischemia time (WIT) necessary for tumor resection. WIT can be reduced using preoperative selective embolization of tumor vessels (PSET).
The aim of this study is to compare the decline of eGFR between patients treated by PSET and laparoscopic PN (LPN) and patients treated by standard renal artery clamping and robot assisted PN (RAPN).


Methods :

Between July 2017 and March 2018, 5 consecutive patients, median age 70 (55-75) years, were successfully treated using PSET and LPN. PSET was done using coils to occlude tumor feeding arteries after the third division of the renal artery. In 2 of these, a short renal artery clamping was necessary.
Another 16 consecutive patients, median age 67 (48-84) years, underwent RAPN with standard renal artery clamping during the tumor surgery time.
Renal tumor complexity was assessed according to the RENAL nephrometry score.
Regression analysis was applied for assessing the relationship between WIT and the decline in eGFR in the RAPN patients.
A two-sample t-test was used to assess differences between both groups. The linear regression model was used for predicting the decline in eGFR when WIT was set to 25 minutes.


Results :

The median RENAL score in the LPN and RAPN group was 6 (5-9) and 6 (4-8) respectively (p=1).
The median WIT in the LPN group was 5 (0-8) min and 21 (10-30) min in the RAPN group.
The mean of early postoperative renal function decline was 5 (0-9) 1.8 ml/min/1.73 m2 in the LPN group and 21 (3-41) 1.8 ml/min/1.73 m2 in the RAPN group (p=0.0125). Figure 1.
The threshold of WIT for detectable decline in eGFR was 6 min.
We found a strong linear correlation between WIT and a decline in the eGFR in the RAPN patients (p<0.01). Figure 2. Setting WIT to 25 min resulted in a reproducible decline in eGFR of 25 units (95% CI: 8-43).


Conclusions :

Preoperative selective embolization of tumor vessels followed by LPN shortened WIT and preserved kidney function more significantly compared to the operative approach using standard renal artery clamping and RAPN.

Jacob Midtlid Lauridsen

Urologist
Dpt. of Urology, Oslo University Hospital
Oslo, Oslo, Norway

Rolf Eigil Berg

Consultant Urologist
Dpt.of Urology, Oslo Univerisity Hospital
Oslo, Oslo, Norway

Dag Bay

Radiologist
Dpt.of Radiology and Nucelar Medicine, Oslo University Hospital
Oslo, Oslo, Norway

Ole Jørgen Grøtta

Radiologist
Dpt.of Radiology and Nucelar Medicine, Oslo University Hospital
Oslo, Oslo, Norway

Gunnar Sandbæk

Radiologist
Dpt.of Radiology and Nucelar Medicine, Oslo University Hospital
Oslo, Oslo, Norway

Nils Einar Kløw

Radiologist
Dpt.of Radiology and Nucelar Medicine, Oslo University Hospital
Oslo, Oslo, Norway

Eivind B. Fosse

Statistician
Norwegian Institut of Technology
Oslo, Oslo, Norway

Andreas Hopland

Urologist
Dpt.of Urology, Oslo University Hospital
Oslo, Oslo, Norway

Eduard Baco

Consultant Urologist
Dpt. of Urology, Oslo University Hospital
Oslo, Oslo, Norway