MP64-02 CLAMPING TECHNIQUE IN PARTIAL NEPHRECTOMY HAS MINIMAL LONG TERM EFFECT ON RENAL FUNCTION IN PATIENTS UNDERGOING A ROBOTIC ASSISTED SURGERY: MINIMUM 6 MONTH FOLLOW UP

Abstract

You have accessJournal of UrologyKidney Cancer: Localized V1 Apr 2014MP64-02 CLAMPING TECHNIQUE IN PARTIAL NEPHRECTOMY HAS MINIMAL LONG TERM EFFECT ON RENAL FUNCTION IN PATIENTS UNDERGOING A ROBOTIC ASSISTED SURGERY: MINIMUM 6 MONTH FOLLOW UP Louis Spencer Krane, Jason Sandberg, Ted B. Manny, and Ashok Kumar Hemal Louis Spencer KraneLouis Spencer Krane More articles by this author , Jason SandbergJason Sandberg More articles by this author , Ted B. MannyTed B. Manny More articles by this author , and Ashok Kumar HemalAshok Kumar Hemal More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1919AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent publications have encouraged use of unclamped robotic assisted partial nephrectomy (RPN) to improve long-term renal function and prevent chronic kidney disease (CKD). We performed many of these procedures in a non-randomized fashion and then evaluated both early and long-term renal functional outcomes. METHODS From a review board approved, prospectively maintained database we included all patients and subdivided these into either a Artery and Vein (AV), Artery Only (AO) or unclamped procedure. Patients were considered having acute kidney injury (AKI) with a 25% decrease in eGFR during hospitalization. Worsening of long term renal function was defined as progression to higher CKD stage. eGFR was calculated using the MDRD equation. Patients with solitary kidneys were excluded form analysis. ANOVA analysis was used for continuous variables, chi-squared for nominal variables, logistic regression for AKI during hospitalization and Cox proportion hazards model created for risk of CKD progression. RESULTS We identified 252 patients with at least 6 month follow up renal functional outcomes following RPN (Median 19 months). In patients who had clamped procedure, median ischemia time was 18 minutes (IQR 14 – 26). Demographic results are summarized in Table 1. 51 (20%) of patients had AKI during hospitalization. Using logistic regression analysis with a model including preoperative GFR, clamping technique, age, and tumor size, only increasing tumor size (p = 0.02) and preoperative GFR (p=0.008) was associated with AKI during hospitalization. 23 (9%) of patients had CKD progression. Univariate cox proportion hazards for CKD progression is demonstrated in Table 2. CONCLUSIONS When performing robotic assisted partial nephrectomy long-term renal function appears unaffected by technique of hilar clamping in patients with contralateral functional renal units. We advocate the physician use the safest technique for renal vascular control, and individualize this for each patient. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e700-e701 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Louis Spencer Krane More articles by this author Jason Sandberg More articles by this author Ted B. Manny More articles by this author Ashok Kumar Hemal More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...