MP50-10 RISKS AND BENEFITS OF PARTIAL NEPHRECTOMY WITH LIMITED OR WITHOUT ISCHEMIA TIME

Abstract

You have accessJournal of UrologyCME1 May 2022MP50-10 RISKS AND BENEFITS OF PARTIAL NEPHRECTOMY WITH LIMITED OR WITHOUT ISCHEMIA TIME Alessandro Larcher, Daniele Cignoli, Giuseppe Fallara, Giuseppe Rosiello, Giuseppe Basile, Gianmarco Colandrea, Gianfranco Baiamonte, Francesco Cei, Giacomo Musso, Daniela Canibus, Roberto Bertini, Pierre I. Karakiewicz, Alexandre Mottrie, Federico Dehò, Andrea Gallina, Francesco Montorsi, Andrea Salonia, and Umberto Capitanio Alessandro LarcherAlessandro Larcher More articles by this author , Daniele CignoliDaniele Cignoli More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Giuseppe RosielloGiuseppe Rosiello More articles by this author , Giuseppe BasileGiuseppe Basile More articles by this author , Gianmarco ColandreaGianmarco Colandrea More articles by this author , Gianfranco BaiamonteGianfranco Baiamonte More articles by this author , Francesco CeiFrancesco Cei More articles by this author , Giacomo MussoGiacomo Musso More articles by this author , Daniela CanibusDaniela Canibus More articles by this author , Roberto BertiniRoberto Bertini More articles by this author , Pierre I. KarakiewiczPierre I. Karakiewicz More articles by this author , Alexandre MottrieAlexandre Mottrie More articles by this author , Federico DehòFederico Dehò More articles by this author , Andrea GallinaAndrea Gallina More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , and Umberto CapitanioUmberto Capitanio More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002625.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To achieve the shortest ischemia time[IT] during partial nephrectomy[PN] for renal mass is regarded as an optimal surgical outcome. However, the relationship between IT and renal function is not entirely elucidated and no consideration is given to potential detriments of zero-ischemia PN techniques. The hypothesis of the study states that IT might have a marginal impact on hard clinical outcomes and conversely might be associated with increased hemorrhagic risk. METHODS: 1,140 patients treated with elective PN for a cT1-2 cN0 cM0 renal mass were prospectively assessed. IT was defined as the duration of clamping of the main artery of the kidney without any refrigeration. The primary outcomes of the study were renal function defined as postoperative, 6-month and long term eGFR, measured between 1 and 5 years after surgery and all-cause mortality. The secondary outcome of the study was haemorrhagic risk defined as estimated blood loss[EBL] and perioperative transfusions. Multivariable linear, logistic and Cox regression analysis[MVA] accounting for age, clinical size, preoperative eGFR and year of surgery were used and the potential non-linear relationship between IT and the study outcomes was modelled using restricted cubic splines. RESULTS: The median duration of IT was 15. The rate of PN without IT was 24%. At MVA predicting renal function, longer IT resulted associated with decreased postoperative eGFR(Est -0.2; p<0.0001). Conversely, no association between IT and eGFR was recorded at 6 month or at long term follow-up nor any association between IT and mortality was recorded(all p>0.1). At MVA predicting hemorrhagic risk, IT resulted associated with EBL(Est -22; p=<0.0001) and perioperative transfusion(OR 0.99; p=0.002). CONCLUSIONS: Patients and clinicians should be aware that performing PN with very limited or even without IT might increase bleeding and need for perioperative transfusions and does not improve long-term renal function nor affects mortality risk. The large study population represents a peculiar strength in the interpretation of such negative finding. These findings underscore the importance of other determinants of renal function, such as residual parenchyma and multidisciplinary postoperative management and advise to always prepare renal hilum during PN and to immediately clamp in case of bleeding. Source of Funding: no © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e868 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alessandro Larcher More articles by this author Daniele Cignoli More articles by this author Giuseppe Fallara More articles by this author Giuseppe Rosiello More articles by this author Giuseppe Basile More articles by this author Gianmarco Colandrea More articles by this author Gianfranco Baiamonte More articles by this author Francesco Cei More articles by this author Giacomo Musso More articles by this author Daniela Canibus More articles by this author Roberto Bertini More articles by this author Pierre I. Karakiewicz More articles by this author Alexandre Mottrie More articles by this author Federico Dehò More articles by this author Andrea Gallina More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Umberto Capitanio More articles by this author Expand All Advertisement PDF DownloadLoading ...