Impact of robotic partial nephrectomy with and without ischemia on renal functions: experience in 34 cases

Abstract

Objective: In this study we aimed to compare renal functions in patients who underwent robotic partial nephrectomy (RPN) with on-clamp and zero-ischemia techniques. Material and methods:Between 2009 and 2015, 12 off-clamp and 22 on-clamp RPN procedures were performed on a total of 34 patients in two centers. The main outcome parameters examined were serum creatinine, and estimated glomerular filtration rate (eGFR) during preoperative, immediate postoperative periods, and at postoperative 3 rd months.Results: There were no statistically significant differences between on-clamp and zero-ischemia groups regarding age, ASA score, BMI, PADUA and R.E.N.A.L. nephrometry scores, operation time and tumor size (p>0.05). Significant differences were found in the duration of hospital stay (3.8±0.9 days vs. 3.0±0.9 days) and amount of blood loss (85.9±49.6 mL vs. 183.3±176.2 mL) between the on-clamp and zero-ischemia groups (p<0.05). Statistically significant differences were found between preoperative and immediate postoperative periods, in terms of eGFR and serum creatinine levels in both groups. Moreover, statistically significant differences were found between preoperative and postoperative 3 rd month periods, in the on-clamp group in terms of eGFR and serum creatinine levels. In the zero-ischemia group, the decrease in eGFR and serum creatinine levels at postoperative 3 rd month relative to the preoperative period was not statistically significant. Conclusion:Off-clamp RPN technique is superior, in short-term outcomes involving renal functions, compared to on clamp approach. However, long-term data regarding the renal functions should be evaluated to arrive at a definitive decision.

Off-clamp partial nephrectomy has a positive impact on short- and long-term renal function: a systematic review and meta-analysis

“…Table 1 summarizes the characteristics of the included studies [ 9 , 15 – 38 ]. Among eligible studies, two were prospective cohort studies (level of evidence: 2b) [ 28 , 35 ], 19 were retrospective studies comparing contemporary series of patients (level of evidence: 3b) [ 9 , 15 , 16 , 18 – 21 , 23 , 25 , 27 , 29 – 34 , 36 – 38 ], and the remaining 4 studies used a historical series as controls (level of evidence: 4) [ 17 , 22 , 24 , 26 ]. A total of 14 studies containing a total number of ≤110 patients were considered as small-sample studies [ 9 , 15 – 20 , 23 , 28 , 29 , 34 – 36 , 38 ], whereas those containing over 110 patients in all were considered as large-sample studies [ 21 , 22 , 24 – 27 , 30 – 33 , 37 ].…”

“…A total of 14 studies containing a total number of ≤110 patients were considered as small-sample studies [ 9 , 15 – 20 , 23 , 28 , 29 , 34 – 36 , 38 ], whereas those containing over 110 patients in all were considered as large-sample studies [ 21 , 22 , 24 – 27 , 30 – 33 , 37 ].…”

“…The pooled analysis for short-term change of Cr level indicated a significantly higher Cr level increase in the on-PN group compared with that in the off-PN group. While most of the included studies showed a higher increase in the on-PN group [ 15 , 17 , 20 , 23 , 24 , 26 , 28 , 34 ], the remaining study reported by Kane et al [ 16 ] showed a higher increase, which was probably driven more by a 38% larger tumor size than by the effect of renal artery occlusion in the off-PN group than in the on-PN group. All included studies showed a higher postoperative short-term Cr level in the on-PN group than in the off-PN group in accordance with a pooled meta-analysis for the postoperative short-term Cr level; this result also indicates the better renal functional outcome of off-PN.…”

“…Within the postoperative 3 months, the short-term decrease in eGFR was found in both groups in almost all the eligible studies [ 19 , 24 , 26 , 28 , 32 , 34 , 35 , 38 ], except for Taweemonkongsap et al [ 9 ] and Kaczmarek et al [ 27 ]. The postoperative short-term eGFR of the off-PN group reported by Taweemonkongsap et al [ 9 ] and Kaczmarek et al [ 27 ] achieved an increase compared with preoperative eGFR (mean: 2.225 ml/min/1.73 m 2 and 1.4 ml/min/1.73 m 2 , respectively).…”

Evaluation von Padua- und R.E.N.A.L.-Score hinsichtlich ihrer Aussagekraft und Implikationen auf das perioperative Management bei der partiellen Nephrektomie

“…Zu den methodischen Aspekten dieser Arbeit ist weiterhin zu erwähnen, dass die Interobserver-Variabilität für die Erstellung des Padua-und R.E.N.A.L.-Scores als von der klinischen Erfahrung abhängig charakterisiert werden konnte [12]. Die Roboter-assistierte partielle Nephrektomie, die als Operationstechnik bei fast allen (> 97 %), in diese Untersuchung eingeschlossenen Patienten zum Einsatz kam, als zunehmend häufig verwendete Methode, findet sich auch in vielen anderen Studien als hauptsächlich verwendete OP-Technik wieder [5,13]. Hier wird die rasche Entwicklung der Nierenchirurgie in den letzten Jahren besonders deutlich.…”