Are warm ischemia and ischemia time still predictive factors of poor renal function after partial nephrectomy in the setting of elective indication?
OBJECTIVE
To evaluate renal function and to identify factors associated with renal dysfunction in the elective indications setting of nephron-sparing surgery (NSS).


METHODS
We retrospectively reviewed operative data and glomerular filtration rate (GFR) of 519 patients treated by NSS in an elective indications setting between 1984 and 2006 in eight academic institutions. A GFR decrease under the thresholds of 60 or 45 ml/min at last follow-up was considered a significant renal dysfunction. Univariate and multivariate regression models were used to assess multiple factors of renal function.


RESULTS
Median age, tumor size, preoperative, and final GFR were 59.5 years (27-84), 2.7 cm (0.9-11), 79 (45-137), and 69 ml/min (p < 0.0001), respectively, with a median follow-up of 23 months (1-416). Hilar clamping was performed in 375 procedures (72.3 %). Significant GFR decrease was observed in 89 patients (17.1 %). Median operating time, hilar clamping duration, and blood loss were 137 min (55-350), 22 min (0-90), and 150 ml (0-4150), respectively. At univariate analysis, age (p = 0.002), preoperative GFR (p = 0.001), pedicular clamping (p = 0.01), and ischemia time (p = 0.0001) were associated with renal dysfunction. Age (p = 0.004; HR 1.2), pedicular clamping (p = 0.04; HR 1.3), and ischemia time (p = 0.0001; HR 1.8) remained independent risk factors for renal function deterioration in multivariate analysis.


CONCLUSIONS
Non- or time-limited clamping techniques are associated with preservation of renal function in the elective indications setting of NSS.
Department of Urology, Bicêtre University Hospital, Le Kremlin Bicêtre, France.
Thomas
T
Bessede
Pierre
P
Bigot
Jean-Christophe
JC
Bernhard
Geraldine
G
Pignot
Fabien
F
Boulière
Gregory
G
Verhoest
Maxime
M
Crépel
Laurent
L
Salomon
Nicolas
N
Mottet
Laurent
L
Bellec
Michel
M
Soulié
Jean-Marie
JM
Ferrière
Christian
C
Pfister
Baptiste
B
Albouy
Frederic
F
Pouliot
Thierry
T
Dujardin
Karim
K
Bensalah
Jean-Jacques
JJ
Patard
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000503:physiopathology / Q000601:surgery*; D003250:Constriction; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D009399:Nephrons; D061646:Operative Time; D018579:Patient Selection; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D052096:Warm Ischemia / Q000009:adverse effects* / Q000379:methods