Association between Ureteral Clamping Time and Acute Kidney Injury during Robot-Assisted Radical Cystectomy.

Yudai Ishiyama,Toshio Takagi,Junpei Iizuka,Kazunari Tanabe,Hiroki Ishihara,Tsunenori Kondo,Kazuhiko Yoshida

doi:10.3390/curroncol28060418

Abstract

Robot-assisted radical cystectomy (RARC) is replacing open radical cystectomy (ORC) and requires clamping of the ureters, resulting in a predisposition to postrenal acute kidney injury (AKI). We investigated the association between ureteral clamping or its duration and acute/chronic postoperative kidney function. Patients who underwent radical cystectomy (robotic or open) at two tertiary institutions during 2002–2021 were retrospectively enrolled. In those who underwent RARC, the maximum postoperative percentage serum creatinine level (%sCre) change was plotted against ureteral clamping duration. They were divided into two groups using the median clamping time (210 min), and the maximum %sCre change and percentage estimated glomerular filtration rate (%eGFR) change at 3–6 months (chronic) were compared between the ORC (no clamp), RARC < 210, and RARC ≥ 210 groups. In 44 RARC patients, a weak correlation was observed between the duration of ureteral clamping and %Cre change (R2 = 0.22, p = 0.001). Baseline serum creatinine levels were comparable between the groups. However, %sCre change was significantly larger in the RARC ≥ 210 group (N = 17, +32.1%) than those in the RARC < 210 (N = 27, +6.1%) and ORC (N = 76, +9.5%) groups (both, p < 0.001). Chronic %eGFR change was comparable between the groups. Longer clamping of the ureter during RARC may precipitate AKI; therefore, the clamping duration should be minimized.

Highlights

Radical cystectomy (RC) remains the gold standard treatment for patients with muscleinvasive or high-risk non-muscle-invasive urinary carcinoma of the bladder and is recommended in various guidelines globally [1,2]
Mid-term renal function is reported to be comparable between open RC (ORC) and robot-assisted RC (RARC) or across different urinary diversions [5]
The level of evidence is not very strong, and maximum effort is warranted to avoid acute kidney injury (AKI) [5]. Both AKI and long-term renal function outcomes are attributed to various factors, including preoperative renal function, hypertension, and diabetes; it is quite challenging to evaluate the effects of ureteral clamping on short-term renal function

Summary

Introduction

Radical cystectomy (RC) remains the gold standard treatment for patients with muscleinvasive or high-risk non-muscle-invasive urinary carcinoma of the bladder and is recommended in various guidelines globally [1,2]. One of the distinct features of minimally invasive surgery in comparison with the open approach in RC is the clamping of ureters during the intracorporeal procedures. Mid-term renal function is reported to be comparable between ORC and RARC or across different urinary diversions [5]. The level of evidence is not very strong, and maximum effort is warranted to avoid acute kidney injury (AKI) [5]. Both AKI and long-term renal function outcomes are attributed to various factors, including preoperative renal function, hypertension, and diabetes; it is quite challenging to evaluate the effects of ureteral clamping on short-term renal function

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