1. Impact of warm versus cold ischemia on renal function following partial nephrectomy.
- Author
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Eggener SE, Clark MA, Shikanov S, Smith B, Kaag M, Russo P, Wheat JC, Wolf JS Jr, Matin SF, Huang WC, Harel M, Cambio J, Shalhav AL, and Raman JD
- Subjects
- Adult, Age Factors, Aged, Aged, 80 and over, Carcinoma, Renal Cell pathology, Carcinoma, Renal Cell physiopathology, Female, Glomerular Filtration Rate physiology, Humans, Kidney pathology, Kidney surgery, Kidney Neoplasms pathology, Kidney Neoplasms physiopathology, Linear Models, Male, Middle Aged, Sex Factors, Treatment Outcome, Tumor Burden, Carcinoma, Renal Cell surgery, Cold Ischemia methods, Kidney physiopathology, Kidney Neoplasms surgery, Nephrectomy methods, Warm Ischemia methods
- Abstract
Introduction: We evaluated renal function following partial nephrectomy with cold ischemia (CI) versus warm ischemia (WI)., Methods: Data were collected from 1,396 patients at six institutions who underwent partial nephrectomy for a renal mass with normal contralateral kidney to evaluate percent change in glomerular filtration rate (GFR) at 3-18 months. A multivariate linear regression model tested the association of percent change GFR with clinical, operative, and pathologic factors., Results: A total of 874 patients (63 %) underwent PN with CI and 522 (37 %) with WI. All patients undergoing laparoscopic and robotic-assisted partial nephrectomy (n = 443) had WI, whereas 92 % of open partial nephrectomy patients (n = 953) had CI. The CI group had a lower mean baseline GFR (72 vs. 80 ml/min/1.73 m(2)), longer median ischemia time (33 vs. 29 min), and larger mean tumor size (3.2 vs. 2.9 cm) with more advanced pathologic stage (T1b-T3: 25 vs. 16 %) (all p values <0.001). Patients with CI and WI demonstrated 12.3 and 10.1 % reductions in renal function from baseline, respectively (p = 0.067). Increasing age, female gender, and increasing tumor size were associated with reduction in renal function (all p values <0.001). Neither renal hypothermia nor operative technique independently predicted reduced renal function. Sensitivity analyses limited to ischemia time >30 min, baseline estimated glomerular filtration rate <60 ml/min/1.73 m(2), or tumors >4 cm did not significantly alter the findings., Conclusions: Increasing age, female gender, and larger tumor size independently predict a decrease in renal function following partial nephrectomy with a normal contralateral kidney. Within the limitations of a non-randomized comparison, including lack of parenchymal preservation percentage, neither surgical approach (open or laparoscopic) nor presence of hypothermia appears to be associated with long-term renal function.
- Published
- 2015
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