Predictive factors for postoperative renal function after off-clamp, non-renorrhaphy partial nephrectomy

Nakamura, Masaki; Kameyama, Shuji; Ambe, Yoshiki; Teshima, Teruki; Izumi, Taro; Tsuru, Ibuki; Inoue, Yasushi; Yoshimatsu, Tadashi; Inatsu, Hiroki; Amakawa, Ryo; Kusakabe, Makoto; Morikawa, Teppei; Shiga, Yoshiyuki

doi:10.21037/tau-22-321

Cited by 5 publications

(6 citation statements)

References 20 publications

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“…In our previous report, we examined perioperative renal function within 3 months after off-clamp, non-renorrhaphy open partial nephrectomy [ 12 ]. Notably, the renal function at 1 year in the current follow-up study remained nearly comparable to that at 3 months after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…In our previous study, the estimated blood loss served as a predictor for perioperative decline in renal function within the first three months after surgery. We hypothesized that intense use of soft coagulation to control bleeding might damage the renal parenchyma, leading to the loss of renal function [ 12 ]. Over the long term, estimated blood loss remained a predictor of renal function.…”

Section: Discussionmentioning

confidence: 99%

“…However, parenchymal ischemia and reperfusion resulting from hilar clamping could lead to acute kidney injury through production of radical oxygen species. Omitting both renal hilar clamping and renorrhaphy has been reported as an effective approach for preserving renal function during partial nephrectomy in a relatively short period [2,[12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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Predictors of renal function deterioration at one year after off-clamp non-renorrhaphy partial nephrectomy

Nakamura,

Kameyama,

Tsuru

et al. 2024

PLoS ONE

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Background Preservation of renal function is an important goal in renal cell carcinoma-related surgery. Although several case-dependent techniques for renal pedicle clamping and hemostasis have been used, their effects on long-term renal function are controversial. Methods The clinical records of 114 patients who underwent off-clamp non-renorrhaphy open partial nephrectomy at our hospital were retrospectively reviewed. Perioperative estimated glomerular filtration rate (eGFR) preservation was calculated, and predictors of eGFR decline 12 months post-surgery and overtime deterioration of renal function were identified using a multivariate regression analysis. Results The median patient age was 65 years, and the median tumor size was 27 mm. The mean eGFR preservation at 1, 3, and 12 months post-surgery were 90.1%, 89.0%, and 86.9%, respectively. eGFR decline at 1 and 3 months were associated with poor eGFR preservation at 12 months with the odds ratio (95% confidence interval (CI)) of 1.97 and 3.157, respectively. Multivariate regression analyses revealed that tumor size was an independent predictor of eGFR decline at 12 months. Among 65 patients with eGFR preservation over 90% at 1 month post-surgery, eGFR value of 28 patients deteriorated below 90% at 12 months post-surgery compared with preoperative eGFR. Tumor size and eGFR preservation at 1 month were independent predictors of long-term renal function deterioration. Conclusion Tumor size predicted eGFR decline 12 months post-surgery. Only a mild decline in eGFR was observed between 3 and 12 months after open partial nephrectomy. Tumor size and eGFR preservation at 1 month predicted the deterioration of renal function over time.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictors of renal function deterioration at one year after off-clamp non-renorrhaphy partial nephrectomy

Nakamura,

Kameyama,

Tsuru

et al. 2024

PLoS ONE

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“…The depth of thermal denaturation required for hemostasis in partial nephrectomy is thought to be about 4.6 mm, and the soft coagulation technology has been reported to provide stable hemostasis up to this depth ( 3 ). Previous studies have used blunt dissection and soft coagulation systems ( 6 , 11 , 12 , 18 ). Surgical approaches without parenchymal renorrhaphy are feasible and can reduce the incidence of RAP ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of soft coagulation in robot-assisted partial nephrectomy in preventing pseudoaneurysms and its influence on renal function based on propensity score-matched analysis

Hoshina,

Sugihara,

Fujisaki

et al. 2024

Transl Androl Urol

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Background Renal artery pseudoaneurysm (RAP) is one of the most stressful and life-threatening complications of partial nephrectomy, the standard treatment for small renal cell carcinoma. The use of a monopolar soft coagulation system for hemostasis during robot-assisted partial nephrectomy (RAPN) is expected to prevent post-surgical RAP development. In this study, we aimed to investigate how the use of a soft coagulation system in RAPN reduces postoperative pseudoaneurysms and changes renal function over time. Methods The incidence of pseudoaneurysms and postoperative renal function were compared in 208 partial nephrectomies performed between May 2016 and March 2023 at a single institution, with propensity score matching to balance patient backgrounds. Outcomes were analyzed using multivariate logistic or linear regression analyses. Results In total, 80 matched pairs were analyzed. One (1.2%) and eighteen (22.5%) pseudoaneurysms were found in the soft coagulation users and non-users, respectively (P<0.001). Compared to the non-user group, postoperative estimated glomerular filtration rates (eGFRs) in the user group were 89% vs. 96% (P<0.001), 87% vs. 93% (P=0.009), and 88% vs. 92% (P=0.15) at 1, 3, and 12 months, respectively. Subsequent multivariate analyses showed a lower incidence of pseudoaneurysms in the user group with an odds ratio of 0.05 [95% confidence interval (CI): 0.01 to 0.44; P=0.007], and no significant difference in the rate of change in renal function at 12 months postoperatively (−1.1%, 95% CI: −5.5% to 3.3%; P=0.61). Conclusions The use of a soft coagulation system reduces pseudoaneurysm occurrence after partial nephrectomy. Although renal function decreased in the short-term for the use group, no long-term differences were observed.

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“…In this study, Nakamura et al investigated the perioperative renal function and the utility of off-clamp and non-renorrhaphy technique for preserving renal function after open PN ( 7 ). The authors reviewed the clinical records of 138 patients with renal tumors who underwent open PN using off-clamp and non-renorrhaphy techniques at a single institute between 2013 and 2020.…”

mentioning

confidence: 99%

The effectiveness of off-clamp and non-renorrhaphy technique regarding postoperative renal function in patients with partial nephrectomy

Iinuma¹,

Nakane²,

Koie³

2022

Transl Androl Urol

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Predictive factors for postoperative renal function after off-clamp, non-renorrhaphy partial nephrectomy

Cited by 5 publications

References 20 publications

Predictors of renal function deterioration at one year after off-clamp non-renorrhaphy partial nephrectomy

Predictors of renal function deterioration at one year after off-clamp non-renorrhaphy partial nephrectomy

Effectiveness of soft coagulation in robot-assisted partial nephrectomy in preventing pseudoaneurysms and its influence on renal function based on propensity score-matched analysis

The effectiveness of off-clamp and non-renorrhaphy technique regarding postoperative renal function in patients with partial nephrectomy

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