Effectiveness and safety of partial nephrectomy—no ischemia vs. warm ischemia: Systematic review and meta-analysis

Mina-Riascos, Sergio Hernando; Vitagliano, Gonzálo; García‐Perdomo, Herney Andrés

doi:10.4111/icu.20190313

Cited by 12 publications

(7 citation statements)

References 34 publications

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“… 5 , 6 The American Urological Association and European Association of Urology claim NSS as the operation of choice when feasible. 7 , 8 The average estimated blood loss of the laparoscopic approach was universally lower open approach, but warm ischemia time (WIT) was longer. 9 , 10 In a matched-pair study, the renal function was poorer in the laparoscopic PN cohort in the short-term after surgery.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Perioperative Outcomes Between Laparoscopic and Open Partial Nephrectomy for Different Complexity Renal Cell Carcinoma Based on the R.E.N.A.L. Nephrometry Score

Wang

Xiong

et al. 2021

CMAR

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Purpose This study aimed to compare perioperative outcomes of open partial nephrectomy (OPN) and laparoscopic partial nephrectomy (LPN) from a retrospective single-center dataset. Patients and Methods A retrospective single-center analysis of 210 patients who underwent open (n=91) or laparoscopic (n =119) partial nephrectomy for RCC was conducted between 2012 and 2015. All patients were grouped into low complexity, moderate complexity, and high complexity according to the R.E.N.A.L. Nephrometry Score, respectively. The rates of intraoperative and postoperative complications estimated blood loss, warm ischemia time, operative time, conversion of laparoscopic procedure to open surgery, and postoperative length of stay were assessed for both procedures. Results In low complexity group (n=93), patients undergoing LPN (n=52) under ischemia conditions had significantly longer renal artery clamp time (p < 0.001) and operative time (p = 0.001) compared with OPN (n=41). However, patients undergoing LPN had a significantly less postoperative length of stay (p=0.005) and estimated blood loss (p < 0.001) compared with OPN. There was no statistically significant difference in the rates of complications between LPN and OPN. In the moderate complexity group (n=114), 67 and 47 patients underwent LPN and OPN, respectively. LPN had notably longer warm ischemia time (p < 0.001) and operative time (p < 0.001) compared with OPN. There were no statistically significant differences in the rates of complications, estimated blood loss, and postoperative length of stay between LPN and OPN. In the high complexity group (n=3), all patients underwent OPN. Conclusion OPN and LPN procedures performed in patients with low and moderate complexity tumors based on the RENAL Nephrometry score offer acceptable and comparable results. When applied to low complexity tumors, our data suggest that laparoscopic NSS is an effective, minimally invasive therapeutic approach with the advantages of less blood loss, earlier hospital discharge, and more rapid convalescence.

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Section: Introductionmentioning

confidence: 99%

Comparison of Perioperative Outcomes Between Laparoscopic and Open Partial Nephrectomy for Different Complexity Renal Cell Carcinoma Based on the R.E.N.A.L. Nephrometry Score

Wang

Xiong

et al. 2021

CMAR

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“…The ischemia time is an important issue for cases of PN, we used hot ischemia for all cases of PN with a mean time of 13.2±4.1 minutes which was slightly shorter than the time estimated by Mina-Riasco et al (16) which was 20.1±4.25 but this was a statistically insignificant difference.…”

Section: Discissionmentioning

confidence: 86%

Partial Nephrectomy Versus Radical Nephrectomy for Localized Renal Masses: Critical Analysis of Oncological Outcome and Impact on the Renal Function

Amer

Selim

El-Shazly

et al. 2021

The Egyptian Journal of Hospital Medicine

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Background: Management of renal tumors remains a controversial issue especially in small size tumors or special situations as bilateral disease, single kidney, or compromised renal function, nephron-sparing surgery is the case in such situations. Objective: Comparing oncological outcome and impact on renal function of open radical nephrectomy and open partial nephrectomy for management of renal tumors. Patients and methods: Our study was conducted as a non-randomized prospective observational study at the Urology Department, Menoufia University Hospital between December 2018 and June 2020. Forty-eight patients with organconfined renal masses were included in the study. They were divided into two equal groups; (group 1) 24 patients and was treated by PN, and (group 2) 24 patients and was treated by RN. Results: The mean age of our study is 56.6±13.2. Thirty-two patients were males (66.7%), while females represented 16 (33.3%). Hot ischemia was done for all partial nephrectomy cases with a mean time of ischemia 13.2±4.1. We used different techniques included simple enucleation in 17 patients (70.8%), polar nephrectomy in 4 patients (16.7%), and wedge resection in 3 patients (12.5%). Regarding surgical margin, it was free in 21 patients (87.5%) of PN and positive in 3 patients (12.5%) 2 of them missed follow up and 1 showed no recurrence till now. Our patients showed a smooth postoperative course. Conclusion: Both techniques (RN&PN) were comparable in terms of oncological outcomes. Patients tolerated both techniques with no major complications, however partial nephrectomy is advised in the localized renal tumors when technically feasible with less probability of complications and good follow-up data regarding the renal function, the oncological outcome is the same as radical surgery.

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“…The kidney is extremely sensitive to warm ischemia. Literature reported that the warm ischemia period should not exceed 30 min during partial nephrectomy (25)(26)(27). The energy-consuming metabolic activity of cortical cells reduces the consumption of oxygen and ATP, protects renal function, and prolongs the operation time.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of robotic-assisted laparoscopic partial nephrectomy with renal hypothermia perfusion by renal artery balloon catheter in treating patients with complex renal tumors

et al. 2022

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ObjectiveThis study aimed to investigate the safety and efficacy of renal hypothermic perfusion by renal artery balloon catheter during robot-assisted laparoscopic partial nephrectomy (P-RALPN) for patients with complex renal tumors.Materials and methodsWe retrospectively identified 45 patients with complex renal tumors who received standard robot-assisted laparoscopic partial nephrectomy (S-RALPN) and 11 patients treated with P-RALPN from September 2017 to October 2021. Preoperative patients’ characteristics and intraoperative surgical parameters including operating time, blood loss, hospitalization, pre- and post-surgical glomerular filtration rate (GFR), and postoperative survival time were collected and compared between the two groups. The patients’ body temperature, real-time kidney temperature, and short-term renal function were analyzed in the P-RALPN group.ResultsThere was no statistically significant difference on median intraoperative estimated blood loss and postoperative hospitalization between the two groups. Patients who received P-RALPN had a slightly longer operative time than those who received S-RALPN (103.1 versus 125.9; p = 0.09). In the P-RALPN group, the volume of perfusion solution was 533.2 ml (range, 255.0–750.0 ml), the median temperature of kidney was 22.6°C (range, 21.7–24.1°C) after the kidney cools down, and the median minimum intraoperative temperature of patients was 36.1°C (range 35.2–36.7°C). The ischemia time in the S-RALPN group was markedly lower than that in the P-RALPN group (21.5 versus 34.8; p < 0.01). However, the loss of GFR was much higher for the S-RALPN group after the surgery. (28.9 versus 18.4; p < 0.01). Importantly, patients had similar postoperative survival time between the two groups (p = 0.42; HR = 0.27).ConclusionP-RALPN is a safe and feasible surgery in the treatment of patients with complex renal tumors, which provides a new operative approach for clinicians to treat these patients.

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Effectiveness and safety of partial nephrectomy—no ischemia vs. warm ischemia: Systematic review and meta-analysis

Cited by 12 publications

References 34 publications

Comparison of Perioperative Outcomes Between Laparoscopic and Open Partial Nephrectomy for Different Complexity Renal Cell Carcinoma Based on the R.E.N.A.L. Nephrometry Score

Comparison of Perioperative Outcomes Between Laparoscopic and Open Partial Nephrectomy for Different Complexity Renal Cell Carcinoma Based on the R.E.N.A.L. Nephrometry Score

Partial Nephrectomy Versus Radical Nephrectomy for Localized Renal Masses: Critical Analysis of Oncological Outcome and Impact on the Renal Function

Clinical outcomes of robotic-assisted laparoscopic partial nephrectomy with renal hypothermia perfusion by renal artery balloon catheter in treating patients with complex renal tumors

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