Category: Laparoscopic/ Robotic: Other

MP25-11 - Clinical impact on unexpected reduction of postoperative split renal function after robot-assisted partial nephrectomy

Sun, Sep 23
10:00 AM - 12:00 PM

Introduction & Objective :

Ischemia time has been reported to be one of the highest impact factor on postoperative split renal function after partial nephrectomy. However, other factors such as renal parenchymal volume loss and reduced regenerative capacity after injury in the aging kidney have been reported. Volume loss includes not only resection but also ablation, suturing or local infarction. In the present study, impacts of clinical factors on postoperative split renal function were retrospectively evaluated.


Methods :

Between 2012 and 2018, a total of 101 patients who underwent robot-assisted partial nephrectomy were performed. Medical records were reviewed and relationships between clinical data and reduction of postoperative split renal function were evaluated. Function decrease group was defined as postoperatively ≥ 10% reduction from preoperative split renal function (33%). Risk factors for unexpected reduction of postoperative split renal function were investigated by univariate and multivariate statistical analyses.


Results :

Median (range) age, body mass index, tumor size, R.E.N.A.L nephrometry score, PADUA score and preoperative renal function were 60 (29-83), 24.3 (16.1-32.5) kg/m2, 2.7 (1.1-5.1) cm, 7 (4-10), 9 (6-11), 48 (39-59) %, respectively. Median (range) operative time, ischemic time, estimated blood loss and decrease of split renal function were 185 (90-353) minutes, 18 (8-63) minutes, 50 (10-850) mL and 8 (-4-36) %, respectively. Twenty patients were ultimately included in function decrease group (40 patients were in another group). According to univariate analysis, tumor size, approach, presence of suturing renal calyx, WIT, postoperative prolonged fever, continuous elevation of LDH, CRP and WBC. In multivariable analysis, postoperative prolonged fever was independent predictor of unexpected reduction of postoperative split renal function (P=0.00286).


Conclusions : Our results demonstrate that some risks associated with renal infarction, other than ischemia time, affect postoperative renal function. It is suggested that how to spare peri-neoplastic renal parenchyma and vessels as well as how to shorten ischemia time is significant to keep postoperative renal function.

Shingo Nishimura

assistant professor
Department of Urology; Okayama University Graduate School of Medicine; Okayama, Japan
Okayama, Okayama, Japan

Yasuyuki Kobayashi

asisstant professor
Department of Urology; Okayama University Graduate School of Medicine; Okayama, Japan
Okayama, Okayama, Japan

Koichiro Wada

assistant professor
Department of Urology; Okayama University Graduate School of Medicine; Okayama, Japan
Okayama, Okayama, Japan

Yuki Maruyama

graduate student
Department of Urology; Okayama University Graduate School of Medicine; Okayama, Japan
Okayama, Okayama, Japan

I am a urologist at Okayama university in Japan. Thank you for your kindness.

Yosuke Mitsui

Medical staff
Department of Urology; Okayama University Graduate School of Medicine; Okayama, Japan
Okayama, Okayama, Japan

Takuya Sadahira

Clinical Fellow
Department of Urology; Okayama University Graduate School of Medicine; Okayama, Japan
Okayama, Okayama, Japan

Takuya Sadahira M.D.
2011-2013 Resident, Okayama University Hospital, Japan
2013-2016 Resident, Department of Urology, Okayama University Hospital, Japan
2016-present Clinical Fellow, Department of Urology, Okayama Medical Hospital, Japan

Ryuta Tanimoto

assistant professor
Department of Urology; Okayama University Graduate School of Medicine; Okayama, Japan
Okayama, Okayama, Japan

Morito Sugimoto

assistant professor
Department of urology, Okayama University Graduate School of Medicine
Okayama, Okayama, Japan

Motoo Araki

Department of Urology; Okayama University Graduate School of Medicine; Okayama, Japan
Okayama, Okayama, Japan

Toyohiko Watanabe

associate professor
Department of Urology; Okayama University Graduate School of Medicine; Okayama, Japan
Okayama, Okayama, Japan

Yasutomo Nasu

professor
Department of Urology; Okayama University Graduate School of Medicine; Okayama, Japan
Okayama, Okayama, Japan