Toward Individualized Approaches to Partial Nephrectomy: Assessing the Correlation Between Ischemia Time and Patient Health Status (RECORD2 Project)

Abstract

Background: Ischemia time during partial nephrectomy (PN) is among the greatest determinants of acute kidney injury (AKI). Whether this association is affected by the preoperative risk of AKI has never been investigated. Objective: To assess the effect of the interaction between the preoperative risk of AKI and ischemia time on the probability of AKI during PN. Design, setting, and participants: Data of 944 patients treated with on-clamp PN for cT1 renal tumors were extracted from the Registry of Conservative and Radical Surgery for Cortical Renal Tumor Disease (RECORD2) database, a prospective multicenter project. Outcome measurements and statistical analysis: We estimated the preoperative risk of AKI (defined according to the risk/injury/failure/loss/end-stage [RIFLE]

The IRON Study: Investigation of Robot-assisted Versus Open Nephron-sparing Surgery

“…Evidence suggesting that minimally invasive techniques allow for better perioperative outcomes after partial nephrectomy than open surgery is increasing [16] , [17] , and our results are consistent with prior investigations [18] . That said, it is still unclear which is the compelling indication for either a surgeon or an institution to switch from open to minimally invasive surgery [19] .…”

To clamp or not to clamp? A step back to go forward

“…Our findings, in tune with other recent sources [2,3], demonstrated that duration of ischaemia should no longer be considered a critical clinical outcome due to its minimal impact on long-term renal function compared to other factors, particularly patient characteristics and comorbidities.…”

Nephron sparing surgery for a patient with a complicated solitary functioning kidney and a giant pT3 renal cell carcinoma: A case report

“…Previous research suggested that human kidneys could tolerate 30-60 min of controlled clamp ischemia with minor damage renal parenchyma and no acute renal function loss. However, Bravi et al reported that a distinct difference existed in the risk of AKI between patients who had an ischemia time <10 min vs. >20 min (9). In our patient, the ischemia time was much longer than 60 min.…”