Impact of ischemia on renal function after laparoscopic partial nephrectomy: a multicenter study

• Published in: The Journal of urology Vol. 183; no. 5; p. 1714
• Main Authors: Shikanov, Sergey, Lifshitz, David, Chan, Andrea A, Okhunov, Zhamshid, Ordonez, Maria A, Wheat, Jeffrey C, Matin, Surena F, Landman, Jaime, Wolf, Jr, J Stuart, Eggener, Scott E, Shalhav, Arieh L
• Format: Journal Article
• Language: English
• Published: United States 01-05-2010
• Subjects: Analysis of Variance; Female; Humans; Kidney - physiopathology; Kidney Function Tests; Kidney Neoplasms - physiopathology; Kidney Neoplasms - surgery; Laparoscopy - methods; Linear Models; Male; Middle Aged; Nephrectomy - methods; Recovery of Function; Treatment Outcome; Warm Ischemia
• ISSN: 1527-3792
• DOI: 10.1016/j.juro.2010.01.007

We assessed the influence of renal ischemia on long-term global renal function after laparoscopic partial nephrectomy in patients with 2 functioning kidneys in a large, multicenter cohort.
Collected data included demographic, clinical and surgical characteristics, tumor parameters and renal function outcomes at 4 institutions in a total of 401 patients with 2 functioning kidneys who underwent laparoscopic partial nephrectomy. Renal function was assessed in the immediate postoperative period (days 1 to 3) and at last followup (greater than 1 month) using the estimated glomerular filtration rate calculated by the 4-variable Modification of Diet in Renal Disease equation. Ischemia time and covariates were modeled on the percent change in the estimated glomerular filtration rate using linear regression.
Median ischemia time was 29 minutes (IQR 22, 34). The postoperative change and the last (long-term) change in the estimated glomerular filtration rate were -16% and -11%, respectively. Median time to the last estimated glomerular filtration rate measurement was 13 months (IQR 6, 24). On multivariate analysis shorter ischemia and operative times, external or ureteral irrigation with cold saline and female gender were associated with less postoperative percent change in the estimated glomerular filtration rate. Smaller tumor size and absent diabetes were associated with less of a final percent change in the estimated glomerular filtration rate. Ischemia time was not associated with a percent change in the estimated glomerular filtration rate at last followup.
Within the range of times in these series renal ischemia did not have a clinically significant impact on global renal function in patients with 2 functioning kidneys who underwent laparoscopic partial nephrectomy, as measured by the estimated glomerular filtration rate.