PD16-02 IMPACT OF RENAL SURGERY ON OVERALL, ONCOLOGIC, AND CARDIAC MORTALITY IN PATIENTS WITH STAGE I RENAL CELL CARCINOMA AND WITHOUT PREOPERATIVE RENAL INSUFFICIENCY

Abstract

INTRODUCTION AND OBJECTIVES: Renal hilar clamping during partial nephrectomy can cause ischemia/reperfusion injury to the surgically preserved parenchyma, which may disturb renal oxygenation after release of blood flow. To minimize this damage, artery-only (AO) clamping has been proposed instead of artery-vein (AV) clamping. In this study, we measured renal oxygenation before and after hilar clamping during partial nephrectomy with AO and AV occlusion. METHODS: We included 34 patients who underwent open and laparoscopic partial nephrectomy with warm ischemia at our institute between 2009 and 2012. AO and AV occlusion was performed in 26 and 8 patients, respectively. Renal parenchymal arterial oxygen saturation (SaO2) was recorded before hilar clamping and 5minute after declamping using T.OxTM Tissue Oximeter (ViOptix, Fremont, CA, USA). All patientsi effective renal plasma flow (ERPF) were evaluated by 99mTc-MAG3 renal scintigraphy and estimated glomerular filtration rate (eGFR) was measured before and 1 week after surgery. RESULTS: Mean ischemia time was 27 min and 31 min in AO and AV group, respectively (p 1⁄4 0.930). The SaO2 for AO and AV decreased by 4.0% and 15.0%, respectively (p 1⁄4 0.037). The change of ERPF in the operated kidney was -47.2 vs -49.0 ml/min/1.73m2 (p 1⁄4 0.637). The change of eGFR was -12.8 vs -18.5 ml/min/1.73m2 (p 1⁄4 0.190). Pearsoni correlation coefficient showed a significant correlation of the change of SaO2 with the change of eGFR (p 1⁄4 0.032), but not with ischemia time (p 1⁄4 0.167), or the change of ERPF in the operated kidney (p 1⁄4 0.225). The SaO2 for the group in which eGFR deteriorated <10 ml/min/1.73m2 decreased by 0.2%, while the SaO2 for the group in which eGFR deteriorated iÝ10 ml/min/1.73m2 decreased by 10.3%, respectively (p 1⁄4 0.032). CONCLUSIONS: The results of this study demonstrate a significant retrograde venous oxygen delivery by applying AO occlusion technique. The decrease of renal function tends to be smaller in the AO clamping group compared with the AV clamping group. This improvement may be the result of the minimization of renal parenchymal oxygenation deterioration.