Partial Nephrectomy In Solitary Kidney Research Articles

Partial nephrectomy in solitary kidneys: comparison between open surgery and robotic-assisted laparoscopy on perioperative and functional outcomes (UroCCR-54 study).

The management of solitary kidney tumors is a surgical challenge, requiring irreproachable results on both oncological and functional outcomes. The goal of our study was to compare the perioperative results of robotic-assisted partial nephrectomy (RAPN) to open surgery in this indication. We led a multicentric study based on the prospectively maintained French national database UroCCR. Patients who underwent partial nephrectomy on a solitary kidney between 1988 and 2020 were included. Clinical and pathological data were retrospectively analyzed. The main outcome of the study was the analysis of the variation of the estimated glomerular filtration rate (eGFR) calculated according to MDRD at 3, 6, 12, and 24months depending on the chosen surgical approach. The secondary outcomes were the comparison of Trifecta success, perioperative complications, and length of hospital stay. In total, 150 patients were included; 68 (45%) in the RAPN group and 82 (55%) in the open surgery group. The two groups were comparable for all data. The variation of eGFR at 3, 6, 12, or 24months was comparable without any significant difference between the 2 groups (p = 0.45). Trifecta was achieved in 40% of the patients in the RAPN group and 33% in the open group (p = 0.42). A significant difference was observed for the length of stay, 5days for the robot group versus 9days for the open surgery group (p < 0.0001). In our study, the surgical approach did not modify functional results and we noted a significant decrease in hospital stay and complications in the RAPN group. RAPN is a safe and efficient method for management of kidney tumors in solitary kidneys.

V10-12 COMPLEX PARTIAL NEPHRECTOMY IN SOLITARY KIDNEY

You have accessJournal of UrologyCME1 May 2022V10-12 COMPLEX PARTIAL NEPHRECTOMY IN SOLITARY KIDNEY Nimrod Barashi Gozal, Brijesh Patel, Mark Biebel, Joseph Ippolito, and Robert Figenshau Nimrod Barashi GozalNimrod Barashi Gozal More articles by this author , Brijesh PatelBrijesh Patel More articles by this author , Mark BiebelMark Biebel More articles by this author , Joseph IppolitoJoseph Ippolito More articles by this author , and Robert FigenshauRobert Figenshau More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002623.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Management of renal masses in solitary kidneys can pose a challenging dilemma. Important considerations include feasibility of mass resection with adequate renorrhaphy, limiting ischemia time, and preservation of nephrons to avoid dialysis. We present a complex robot-assisted partial nephrectomy (RAPN) in a 55 year-old female with a solitary left kidney, incidentally found to have a 5.7cm left renal mass that was centrally located, completely endophytic, with a R.E.N.A.L Nephrometry score of 11, and a baseline creatinine of 1.06 mg/dL. METHODS: The patient was placed in right lateral decubitus position with the left flank flexed. Pneumoperitoneum was achieved with a Veress needle, and four robotic 8 mm ports were placed in a straight line along the lateral edge of the rectus with a 12 mm assistant port in the midline. A remotely operated suction irrigation (ROSI) system was utilized. After the colon was medialized, hilar dissection was started with identifying the renal vein (RV), and immediately posterior and cephalad was the renal artery (RA). Intraoperative ultrasonography was performed to demarcate borders of mass excision, since the mass was completely endophytic. Approximately 50% of mass excision was performed with selective clamping of the artery supplying the tumor, but the main RA was eventually clamped to help control bleeding. The mass, along with a segment of tumor thrombus, was grossly excised to completion. Renorrhaphy was started with a 3-0 v-lock suture over-sewing the base of mass excision to control bleeding followed by simple interrupted 0-vicryl suture to bring edges of resection together. These were secured with two Hem-o-lok clips. Gerota’s fascia was re-approximated with a 3-0 v-lock suture, and the specimen was placed in a Endocatch bag for extraction through a Gibson incision. RESULTS: Procedure time was 5 hours and 13 minutes. Estimated blood loss (EBL) was 1,500 mL. Pathology showed clear cell RCC, Furhman grade 3, with lymphovascular invasion and a positive surgical margin at the RV. Post-operatively, the patient experienced a oliguric renal failure, with creatinine (Cr) peaking at 8.5 mg/dL on postoperative day 4. Following that, urine output increased to over 2 liters daily, and Cr fell to 5.5 mg/dL by POD#9, at which time the patient was discharged. At one month follow-up, Cr was 1.49 mg/dL. At no point did the patient have any dialysis needs. CONCLUSIONS: A number of difficult challenges exist for complex RAPN in solitary kidneys. Performing as much of the procedure as possible without clamping the main renal artery may increase blood loss but will also facilitate renal recovery. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e852 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nimrod Barashi Gozal More articles by this author Brijesh Patel More articles by this author Mark Biebel More articles by this author Joseph Ippolito More articles by this author Robert Figenshau More articles by this author Expand All Advertisement PDF DownloadLoading ...

On-clamp versus purely off-clamp robot-assisted partial nephrectomy in solitary kidneys: comparison of perioperative outcomes and chronic kidney disease progression at two high-volume centers.

Minimal literature describes the impact of hilar control on the progression to chronic kidney disease (pCKD) after robotic partial nephrectomy (RPN) in solitary kidneys (SK). The aim of this study was to compare purely off-clamp (ocRPN) vs. on-clamp robotic partial nephrectomy (onRPN) in SK and to identify predictors of pCKD at two high-volume centers. Between December 2013 and October 2019, 54 patients with SK underwent ocRPN and onRPN for renal tumors at two institutions. Baseline and perioperative data were analyzed. Newly onset of CKD stage 3b,4,5 (CKD3b,4,5) was assessed by Kaplan-Meier curves and compared for warm ischemia time (WIT) with the log-rank test. Cox regression analysis was used to identify predictors of pCKD. At a median follow-up of 13 months (IQR 6.3-34), newly onset of CKD3b and CKD 4.5 were observed in 11.1% and 7.4% of patients, respectively. onRPN was associated with a higher risk of progression to CKD 3b,4,5 stages (P=0.034) and higher rate of perioperative complications (P=0.03). On univariable analysis eGFR at discharge (eGFRd), positive surgical margins status (PSM) and WIT were predictors of newly onset of CKD3b,4,5 (each P<0.05). Multivariable analysis identified eGFRd (HR 0.88; CI 95% 0.81-0.96) and WIT (HR 1.09; CI 95% 1.02-1.16) as independent predictors of pCKD (each P<0.01). Main limitations include the retrospective nature of the study, the short-term follow-up and the lack of data adjustment for parenchymal volume loss. eGFRd and WIT during RPN are independent predictors of pCKD in SK. In this setting a critical reduction of WIT should be achieved according to the oncologic outcome. In patients with SK, WIT represents the only surgical modifiable factor of RPN for avoiding a quicker onset of pCKD.

PE58 - Robotic partial nephrectomy in solitary kidney: Feasibility and outcome

PE58 - Robotic partial nephrectomy in solitary kidney: Feasibility and outcome

Reply by Authors.

No AccessJournal of UrologyAdult Urology1 Mar 2021Reply by Authorsis a reply to letterEditorial Comment Pierluigi Bove, Riccardo Bertolo, Marco Sandri, Chiara Cipriani, Costantino Leonardo, Paolo Parma, Mario Falsaperla, Domenico Veneziano, Antonio Celia, Andrea Mari, Andrea Minervini, and Alessandro Antonelli Pierluigi BovePierluigi Bove *Correspondence: “San Carlo di Nancy” Hospital – GVM Care & Research, Via Aurelia 275, 00165Rome , Italy telephone: +390639976456; FAX: +390639976504; E-mail Address: [email protected] Urology Department, San Carlo di Nancy Hospital, Rome, Italy Urology Unit, Department of Surgery, Tor Vergata University of Rome, Rome, Italy More articles by this author , Riccardo BertoloRiccardo Bertolo Urology Department, San Carlo di Nancy Hospital, Rome, Italy More articles by this author , Marco SandriMarco Sandri Big & Open Data Innovation Laboratory (BODaI-Lab), University of Brescia, Brescia, Italy More articles by this author , Chiara CiprianiChiara Cipriani Urology Department, San Carlo di Nancy Hospital, Rome, Italy More articles by this author , Costantino LeonardoCostantino Leonardo Department of Urology, La Sapienza University of Rome, Rome, Italy More articles by this author , Paolo ParmaPaolo Parma Department of Urology, Ospedale “Carlo Poma” Mantova, Mantova, Italy More articles by this author , Mario FalsaperlaMario Falsaperla Department of Urology, ARNAS Garibaldi Hospital, Catania, Italy More articles by this author , Domenico VenezianoDomenico Veneziano Department of Urology and Kidney Transplantation, O.O. Riuniti BMM, Reggio Calabria, Italy More articles by this author , Antonio CeliaAntonio Celia Department of Urology, San Bassiano Hospital, Bassano Del Grappa, Italy More articles by this author , Andrea MariAndrea Mari Department of Urology, Careggi Hospital, University of Florence, Florence, Italy. More articles by this author , Andrea MinerviniAndrea Minervini Department of Urology, Careggi Hospital, University of Florence, Florence, Italy. More articles by this author , and Alessandro AntonelliAlessandro Antonelli Unit of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy. Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy More articles by this author on Behalf of the AGILE Group (Italian Group for Advanced Laparo-Endoscopic Surgery) View All Author Informationhttps://doi.org/10.1097/JU.0000000000001417.02AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Reply by Authors." The Journal of Urology, 205(3), p. 685 Reference 1. : On-clamp versus purely off-clamp robot-assisted partial nephrectomy in solitary kidneys: comparison of perioperative outcomes and chronic kidney disease progression at two high-volume centers. Minerva Urol Nefrol 2020; doi: 10.23736/S0393-2249.20.03795-9. Crossref, Google Scholar © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology23 Dec 2020Editorial Comment Volume 205Issue 3March 2021Page: 685-685 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pierluigi Bove Urology Department, San Carlo di Nancy Hospital, Rome, Italy Urology Unit, Department of Surgery, Tor Vergata University of Rome, Rome, Italy *Correspondence: “San Carlo di Nancy” Hospital – GVM Care & Research, Via Aurelia 275, 00165Rome , Italy telephone: +390639976456; FAX: +390639976504; E-mail Address: [email protected] More articles by this author Riccardo Bertolo Urology Department, San Carlo di Nancy Hospital, Rome, Italy More articles by this author Marco Sandri Big & Open Data Innovation Laboratory (BODaI-Lab), University of Brescia, Brescia, Italy More articles by this author Chiara Cipriani Urology Department, San Carlo di Nancy Hospital, Rome, Italy More articles by this author Costantino Leonardo Department of Urology, La Sapienza University of Rome, Rome, Italy More articles by this author Paolo Parma Department of Urology, Ospedale “Carlo Poma” Mantova, Mantova, Italy More articles by this author Mario Falsaperla Department of Urology, ARNAS Garibaldi Hospital, Catania, Italy More articles by this author Domenico Veneziano Department of Urology and Kidney Transplantation, O.O. Riuniti BMM, Reggio Calabria, Italy More articles by this author Antonio Celia Department of Urology, San Bassiano Hospital, Bassano Del Grappa, Italy More articles by this author Andrea Mari Department of Urology, Careggi Hospital, University of Florence, Florence, Italy. More articles by this author Andrea Minervini Department of Urology, Careggi Hospital, University of Florence, Florence, Italy. More articles by this author Alessandro Antonelli Unit of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy. Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy More articles by this author Expand All Advertisement PDF downloadLoading ...

SC200 - On-Clamp versus purely Off-Clamp robotic partial nephrectomy in solitary kidneys: comparison of chronic kidney disease progression at two high-volume centers

SC200 - On-Clamp versus purely Off-Clamp robotic partial nephrectomy in solitary kidneys: comparison of chronic kidney disease progression at two high-volume centers

On-clamp versus purely off-clamp robot-assisted partial nephrectomy in solitary kidneys: comparison of perioperative outcomes and chronic kidney disease progression at two high- volume centers

Minimal literature describes the impact of hilar control on the progression to chronic kidney disease (pCKD) after robotic partial nephrectomy (RPN) in solitary kidneys (SK). The aim of this study was to compare purely off-clamp (ocRPN) vs. on-clamp robotic partial nephrectomy (onRPN) in SK and to identify predictors of pCKD at two high-volume centers. Between December 2013 and October 2019, 54 patients with SK underwent ocRPN and onRPN for renal tumors at two institutions. Baseline and perioperative data were analyzed. Newly onset of CKD stage 3b,4,5 (CKD3b,4,5) was assessed by Kaplan-Meier curves and compared for warm ischemia time (WIT) with the log-rank test. Cox regression analysis was used to identify predictors of pCKD. At a median follow-up of 13 months (IQR 6.3-34), newly onset of CKD3b and CKD 4.5 were observed in 11.1% and 7.4% of patients, respectively. onRPN was associated with a higher risk of progression to CKD 3b,4,5 stages (P=0.034) and higher rate of perioperative complications (P=0.03). On univariable analysis eGFR at discharge (eGFRd), positive surgical margins status (PSM) and WIT were predictors of newly onset of CKD3b,4,5 (each P<0.05). Multivariable analysis identified eGFRd (HR 0.88; CI 95% 0.81-0.96) and WIT (HR 1.09; CI 95% 1.02-1.16) as independent predictors of pCKD (each P<0.01). Main limitations include the retrospective nature of the study, the short-term follow-up and the lack of data adjustment for parenchymal volume loss. eGFRd and WIT during RPN are independent predictors of pCKD in SK. In this setting a critical reduction of WIT should be achieved according to the oncologic outcome. In patients with SK, WIT represents the only surgical modifiable factor of RPN for avoiding a quicker onset of pCKD.

1051 - Robotic partial nephrectomy in solitary kidneys: Impact of ischemia on trifecta outcomes

1051 - Robotic partial nephrectomy in solitary kidneys: Impact of ischemia on trifecta outcomes

Minimally invasive treatment of complications after laparoscopic partial nephrectomy in solitary kidney

Clinical observations were made regarding the effectiveness of minimally invasive interventions in the treatment of complications after laparoscopic partial nephrectomy in solitary kidney, due to the presence of a tumor. On the first day after the operation, abundant bleeding from the stump of the superior segmental renal artery was noted; this was stopped by selective embolization. On the 7th day after the operation, a urinary fistula was revealed, which developed because of violation of the integrity of the pyelocaliceal kidney system. After stenting of the kidney was performed, urine excretion in the retroperitoneal drainage was stopped.

Re: Acute Kidney Injury After Partial Nephrectomy in Solitary Kidneys: Impact on Long-term Stability of Renal Function

Re: Acute Kidney Injury After Partial Nephrectomy in Solitary Kidneys: Impact on Long-term Stability of Renal Function

RISK GROUPS OF ACUTE KIDNEY INJURY IN PATIENTS AFTER OPERATIVE THERAPY OF TUMORS OF A SOLITARY KIDNEY

The objective of this study is to devise a prognostic classification of AKI in the postoperative period based on preoperative factors for patients after partial nephrectomy for renal masses in the solitary kidney (SK). This method will allow identifying patients in a high risk group and reducing this unfavorable postoperative outcome by a careful treatment planning.We present a series of 136 patients with SK tumor who underwent open partial nephrectomy in situ performed at the N. N. Alexandrov National Cancer Centre of Belarus in 2000–2016. During the early postoperative period, AKI occurred in 28 (20.6 %) patients. Three risk factors associated with a risk of developing AKI were included in the multivariate analysis: categorized risk factors such as tumor size and serum potassium and dichotomous – multifocality. On the basis of the multivariant model presented, 3 risk factors were assigned a weighted score. Depending on the score, the cohort of patients was divided into 3 groups. Patients with a score from 0 to 2 were classified as a low-risk group, 3 points – an intermediate-risk group and ≥4 points – a high-risk group with the development of AKI in the postoperative period.The devised prognostic classification allows one during the preoperative period with a predictive accuracy of 82.3 % to determine a risk of development of AKI after partial nephrectomy of SK. In the low-risk group, the probability of developing AKI after surgery is 5.6 %, in the intermediate-risk group – 2.9 %, in the high-risk group – 68.2 % (р &lt; 0.001).

Prognostic factors of acute renal failure following partial nephrectomy of solitary kidney

Background. Acute renal failure (ARF) in the postoperative period increases the risk of complications and death. Estimating the risk of ARF prior to surgery is particularly important, because it allows modifying the treatment in high-risk patients.Objective: to develop prognostic models for evaluating the risks of ARF in patients undergoing resection of a solitary kidney by measuring preoperative parameters.Materials and methods. The study included 136 patients with tumors in a solitary kidney that underwent surgical treatment in the N.N. Alexandrov National Cancer Center of Belarus in the last 16 years.Results. Biochemical blood tests demonstrated that 28 patients (20.6 %) had ARF in the early postoperative period. The multivariate model for assessing the risk of ARF included the following three covariates: tumor size, multifocality, and serum potassium level. We identified the cut-off points of tumor size (3.6 and 5.2 cm) and potassium level (4.4 and 4.8 mmol/L) that ensured maximum predictive accuracy. Using the multivariate model, we developed a nomogram that allows graphical calculation of the ARF probability in the postoperative period by measuring preoperative parameters.Conclusion. Our model enables preoperative assessment of the risk of developing ARF after resection of a solitary kidney with an accuracy (С-index) of 85.1 % (95 % confidence interval: 79.3–89.7 %).

Striking a balance between renal ischemia and excessive blood loss decreases risk of acute kidney injury following partial nephrectomy of solitary kidney

Striking a balance between renal ischemia and excessive blood loss decreases risk of acute kidney injury following partial nephrectomy of solitary kidney

'Trifecta' outcomes of robot-assisted partial nephrectomy in solitary kidney: a Vattikuti Collective Quality Initiative (VCQI) database analysis.

To analyse the outcomes of robot-assisted partial nephrectomy (RAPN) in patients with a solitary kidney in a large multi-institutional database. In all, 2755 patients in the Vattikuti Collective Quality Initiative database underwent RAPN by 22 surgeons at 14 centres in nine countries. Of these patients, 74 underwent RAPN with a solitary kidney between 2007 and 2016. We retrospectively analysed the functional and oncological outcomes of these 74 patients. A 'trifecta' of outcomes was assessed, with trifecta defined as a warm ischaemia time (WIT) of <20 min, negative surgical margins, and no complications intraoperatively or within 3 months of RAPN. All 74 patients underwent RAPN successfully with one conversion to radical nephrectomy. The median (interquartile range [IQR]) operative time was 180 (142-230) min. Early unclamping was used in 11 (14.9%) patients and zero ischaemia was used in 12 (16.2%). Trifecta outcomes were achieved in 38 of 66 patients (57.6%). The median (IQR) WIT was 15.5 (8.75-20.0) min for the entire cohort. The overall complication rate was 24.1% and the rate of Clavien-Dindo grade ≤II complications was 16.3%. Positive surgical margins were present in four cases (5.4%). The median (IQR) follow-up was 10.5 (2.12-24.0) months. The median drop in estimated glomerular filtration rate at 3 months was 7.0 mL/min/1.72 m2 (11.01%). Our findings suggest that RAPN is a safe and effective treatment option for select renal tumours in solitary kidneys in terms of a trifecta of negative surgical margins, WIT of <20 min, and low operative and perioperative morbidity.

Functional and oncologic outcomes after partial nephrectomy in anatomical solitary kidney

Objective To investigate the effect of partial nephrectomy of anatomical solitary kidney on tumor control and renal function preservation. Methods 10 patients with anatomical solitary kidney underwent partial nephrectomy from December 2007 to May 2016, including 6 males and 4 females ranged from 38 to 71 years old with an average of 57 years old. The PADUA score ranged from 6-10, with an average of 7.6. The tumor diameter ranged from 1.0 to 7.4 cm, with an average of 3.2cm. Results 7 cases underwent laparoscopic surgery. 3 cases underwent open surgery. Mean operation time was 168min (ranged 103-217min). Mean blood loss was 135ml (ranged 20-400ml). The renal arteries were blocked in all patients. The ischemia time ranged from 9 to 33min, with an average of 20.6min. The mean estimated glomerular filtration rate at one week after surgery [40.7ml/(min·1.73 m2)] decreased 44.7% compared with pre-operation [73.6 ml/(min·1.73 m2)]. Acute kidney injury developed in 2 patients. One required temporary dialysis. The other improved after conservative treatment. There were no other complications such as urinary fistula and hemorrhage. The pathology analysis confirmed that 2 cases were angiomyolipoma, one case was benign cyst, 6 cases were renal clear cell carcinoma, and one case was multilocular cystic renal cell carcinoma. 4 cases were stage pT1a, one case was stage pT1b, one case was stage pT2a, and one case was stage pT4. Positive margin was found in one case. The average follow-up period was 28.2 months(ranged 3-58months). Only one patient need long-term dialysis 20 months after surgery at the latest follow up. Another patient had local recurrence and ipsilateral adrenal metastasis. Conclusions Satisfactory effect of tumor control and renal function preservation can be achieved by partial nephrectomy in solitary kidney, which prevent or delay the occurrence of hemodialysis effectively. Key words: Solitary kidney; Kidney neoplasms; Partial nephrectomy

Clinical research of robot-assisted laparoscopic partial nephrectomy in solitary kidney

Objective To investigate the perioperative outcomes of robot-assisted laparoscopic partial nephrectomy in solitary kidney. Methods From September 2014 to September 2015, 9 patients underwent robot-assisted laparoscopic partial nephrectomy in solitary kidney. 6 of these patients were male, while the others were female. The average age of these patients was 60 years, ranged from 46-78 years. The lesion was located in left kidney of 5 cases, and the remaining in right kidney. The average diameter of lesion was 4.5 cm, ranged from 2.8-7.6 cm. One case was congenital solitary kidney, one was contralateral atrophic kidney, 2 cases were performed nephrectomy due to benign lesion, 5 cases were performed radical nephrectomy due to malignancy. All the cases were performed by robot-assisted laparoscopic surgery transperitoneally. Results The surgery of all 9 cases were successfully completed, and no conversion to open surgery. The median operation time was 104-215 min, with an average of 129 min. The estimated blood loss was 50-350 ml, with an average of 120 ml, and there was no blood transfusion. The warm ischemia time was 10-28 min, with an average of 18 min. There was no intraoperative complication occurred. The postoperative length of hospitalization was 8-17 d, with an average of 12 d. One case of urine leakage and another one of secondary hemorrhage were found after operation. The drainage tube and urinary catheter were removed in 3-5 days postoperation. The pathology analysis confirmed that 7 cases were renal clear cell carcinoma, one case was papillary carcinoma and one was angiomyolipoma, the tumor surgical margin was negative in all cases. The follow up duration was 1-12months, no recurrence or metastasis occurred. Conclusions Robot-assisted partial nephrectomy represents a safe and effective minimally-invasive treatment option for kidney neoplasms in patients with a solitary kidney, which provided reliable cancer control and renal function preservation. Key words: Robot; Lapsroscopy; Kidney neoplasms; Partial nephrectomy

Long-Term Oncological and Functional Outcomes of Partial Nephrectomy in Solitary Kidneys

BackgroundIn this study we assessed the efficacy of nephron-sparing surgery and the changes in renal function after surgery in patients with solitary kidneys. Patients and MethodsFrom January 2000 to January 2015, 50 patients with solitary kidneys underwent partial nephrectomy for renal cancer. In 34 of the patients the contralateral kidneys had been removed previously because of renal tumor. The mean age of the patients was 62 ± 10 years. There were 15 women and 35 men. ResultsThe average diameter of the tumors was 35.2 ± 19.5 mm. The mean preoperative aspects and dimensions used for an anatomical classification score was 7.6 ± 0.7. The mean renal ischemia time was 13.8 ± 6.5 minutes. The mean preoperative and the early postoperative glomerular filtration rate (GFR) were 62 ± 21 mL/min/1.73 m2 and 44 ± 18 mL/min/1.73 m2 (P = .0001), respectively. The mean GFR values decreased by 29% at 1 and at 3 years, and by 36% at 5 years after surgery. All changes in postoperative GFR levels were significant compared with the preoperative values. The tumor size and the warm ischemia time were risk factors for the long-term renal function. The mean follow-up time was 106 ± 96 months. During this period local recurrence occurred in 1 patient, and distant metastases were diagnosed in 4 cases. The 5-year overall, disease-specific, and recurrence-free survival were 88%, 93%, and 88%, respectively. ConclusionPartial nephrectomy provides a good oncological outcome. However, after nephron-sparing surgery most patients develop chronic renal disease, although hemodialysis treatment is rarely necessary. The tumor size and the warm ischemia time showed a close correlation with the long-term renal function.

MP59-12 FUNCTIONAL & TRIFECTA OUTCOMES IN SOLITARY KIDNEY: UNCLAMPED VS CLAMPED PARTIAL NEPHRECTOMY

You have accessJournal of UrologyKidney Cancer: Surgical Therapy III1 Apr 2015MP59-12 FUNCTIONAL & TRIFECTA OUTCOMES IN SOLITARY KIDNEY: UNCLAMPED VS CLAMPED PARTIAL NEPHRECTOMY Andre Luis de Castro Abreu, Rocco Papalia, Inderbir Gill, Giuseppe Simone, Mariaconsiglia Ferriero, Riccardo Mastroianni, Kelvin Wong, Raed Azhar, Raj Satkunasivam, Charles Metcalfe, Osamu Ukimura, Monish Aron, Mihir Desai, and Michele Gallucci Andre Luis de Castro AbreuAndre Luis de Castro Abreu More articles by this author , Rocco PapaliaRocco Papalia More articles by this author , Inderbir GillInderbir Gill More articles by this author , Giuseppe SimoneGiuseppe Simone More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Riccardo MastroianniRiccardo Mastroianni More articles by this author , Kelvin WongKelvin Wong More articles by this author , Raed AzharRaed Azhar More articles by this author , Raj SatkunasivamRaj Satkunasivam More articles by this author , Charles MetcalfeCharles Metcalfe More articles by this author , Osamu UkimuraOsamu Ukimura More articles by this author , Monish AronMonish Aron More articles by this author , Mihir DesaiMihir Desai More articles by this author , and Michele GallucciMichele Gallucci More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2172AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To assess renal functional and trifecta outcomes of clamped versus unclamped minimally invasive partial nephrectomy (PN) in patients with a solitary kidney (SK). METHODS We retrospectively analyzed data of 129 patients undergoing PN in solitary kidney at 2 high-volume referral centers (1999-2014). PN was performed either by clamped technique (CC-PN; global renal ischemia with main artery clamped) or by unclamped technique (UC-PN; no global ischemia with no clamping/tumor-specific clamping only). Trifecta after PN was achieved when estimated glomerular filtration rate (eGFR) decreased < 10% from baseline, cancer margins were negative and there were no urological complications in a given patient. Demographics, perioperative, renal function and Trifecta outcomes were analyzed. Exploratory univariate and multivariable Cox regression were applied for predicting Trifecta after MIS-PN (p<0.05 significant). RESULTS CC-PN and UC-PN were performed in 64 and 65 patients, respectively. Mean tumor size (3.4 vs 3.9 cm, p=0.13) and baseline eGFR (60 vs 57, p = 0.34) were similar between groups. UC-PN cohort was older (62 vs 67 yrs, p = 0.02) with more central tumors (48% vs 77%, p =0.001). Robotic PN was more frequent in the UC-PN (17% vs 69%, p < 0.001). UC-PN patients had shorter mean warm ischemia time (WIT; 24 vs 0 min, p =<0.001) and operative time (4.3 vs 3.7 hrs, p = 0.04). Peri-operative outcomes were similar between CC-PN vs UN-PN groups: mean estimated blood loss (514 vs 285 cc, p =0.40), hospital stay (7.4 vs 4.9 days, p =0.86) and transfusion rate (28% vs 15 %, p =0.09). Overall complications trended to be lower for UN-PN (36% vs 20%, p =0.051), however urological complications were similar (11% vs 8%). RCC histology (78% vs 83%) and negative margins (98% vs 96%) were similar. Mean eGFR decrease was 30% for CC-PN vs 6% for UN-PN (p<0.0001). Similarly, in the UC-PN cohort, more patients maintained pre-operative eGFR (22% vs 64%, p < 0.0001) and fewer patients had new-onset CKD stage 3 (33% vs 6%, p < 0.001). Trifecta outcomes were more common in the UC-PN cohort (20% vs 69%, p < 0.0001). On univariate analysis baseline eGFR, WIT and UN-PN were predictors for achieving Trifecta. On multivariate analysis, UN-PN predicted for Trifecta. Main limitation is retrospective analysis and small number of patients. CONCLUSIONS In the solitary kidney setting, unclamped PN conferred superior functional and Trifecta outcomes compared to clamped PN. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e734 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andre Luis de Castro Abreu More articles by this author Rocco Papalia More articles by this author Inderbir Gill More articles by this author Giuseppe Simone More articles by this author Mariaconsiglia Ferriero More articles by this author Riccardo Mastroianni More articles by this author Kelvin Wong More articles by this author Raed Azhar More articles by this author Raj Satkunasivam More articles by this author Charles Metcalfe More articles by this author Osamu Ukimura More articles by this author Monish Aron More articles by this author Mihir Desai More articles by this author Michele Gallucci More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

C143: Oncological and functional outcomes of partial nephrectomy in solitary kidneys

C143: Oncological and functional outcomes of partial nephrectomy in solitary kidneys

MP64-14 “TRIFECTA” AFTER PARTIAL NEPHRECTOMY IN SOLITARY KIDNEY.

MP64-14 “TRIFECTA” AFTER PARTIAL NEPHRECTOMY IN SOLITARY KIDNEY.