Multivariate analysis of the factors involved in loss of renal differential function after laparoscopic partial nephrectomy; a role for warm ischemia time

Abstract

Our results suggest that the factors associated with loss of RDF are not the same before and after 30 minutes of WIT and that the rate of loss in RDF increases after 30 minutes. Since, the effect of WIT is small up to 30 minutes, we believe that surgery should focus on limiting the resection of normal parenchyma and to ensure negative margins and hemostasis, rather than on premature unclamping.

The Impact of Anastomosis Time During Kidney Transplantation on Graft Loss: A Eurotransplant Cohort Study

“…This time span is in line with previously reported effects of anastomosis time on immediate and medium‐term graft function . Similar WITs impair postoperative renal function after clamping during partial nephrectomy in solitary native kidneys . In contrast, in a study on native kidney biopsies after surgical renal clamping for 15–53 min, only mild structural changes and no acute functional loss was observed (the effect on long‐term outcome was not investigated) .…”

Comparison of perioperative, renal and oncologic outcomes in robotic‐assisted versus open partial nephrectomy

“…Despite significantly different rates of arterial clamping, post‐operative eGFR stages were similar between groups, even when adjusted for age and RENAL scores. This supports earlier suggestions that a short WIT as a single parameter may not confer clinically significant detriment on renal function . We found no statistical relationship between WIT and post‐operative eGFR stage, further questioning the clinical importance of the 30‐min WIT cut‐off.…”

Laparoscopic Partial Nephrectomy – Current State of the Art

“…A series of 56 consecutive LPN cases performed by a single surgeon at a single institution, using pre-operative and post-operative MAG3-lasix renal scintigraphy, demonstrated a relationship between WIT (minutes) and renal differentional function (RDF) [5]. Interestingly, the authors noted that the relationship between WIT and declining kidney function was more pronounced after 32 minutes.…”