title: Warm Ischemia-Related Postoperative Renal Dysfunction in Elective Laparoscopic Partial Nephrectomy Recovers During Intermediate-Term Follow-Up.
abstract: OBJECTIVE
  To analyze the impact of warm ischemia time (WIT) on early postoperative and ultimate renal function after elective laparoscopic partial nephrectomy (LPN).
  
  
  METHODS
  One hundred and twenty-seven patients who underwent elective, ischemia-applied LPN were investigated in this study. The study patients were without stage 3 or greater chronic kidney disease (CKD) (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m(2)) before LPN. Initially, the patients were grouped using the criteria of postoperative de novo stage 3 or greater CKD: Group A (n=104, eGFR ≥60 mL/min/1.73 m(2)) and group B (n=23, eGFR <60 mL/min/1.73 m(2)). The patients were also divided into two groups using 27.75 minute cutoff value obtained by receiver operating curve (ROC) analysis for WIT: Group 1 (n=69, WIT <27.75 min) and group 2 (n=58, WIT ≥27.75 min). The groups were compared with regard to demographic, perioperative, histopathologic, and renal functional outcomes.
  
  
  RESULTS
  The decreased preoperative eGFR (P<0.001) and increased WIT (P=0.007), operative time (P=0.015), diabetes mellitus (DM) rate (P=0.019) and pathologic tumor size (P=0.031) were significantly different in group B. Multivariate analysis determined that independent predictors of de novo stage 3 or greater CKD in the early postoperative period were preoperative eGFR (P<0.001), WIT (P=0.014), and DM (P=0.030); meanwhile, preoperative eGFR (P=0.006) was the only independent predictor at last follow-up. Decreased median postoperative eGFR (P=0.018) and percent preserved postoperative eGFR (P=0.001) were significantly different in the increased WIT group, as well as elevated median postoperative eGFR loss (P=0.001). After similar follow-up (26 vs 23.5 months, P=0.913), the increased and limited WIT groups were not significantly different with regard to final eGFR (P=0.936), final eGFR loss (P=0.749) and percent preserved final eGFR (P=0.690).
  
  
  CONCLUSIONS
  In elective LPN, increased WIT plays an important role in renal functional loss in the early postoperative period. This functional loss, however, recovered after an intermediate term follow-up period, similar to that of patients undergoing limited WIT.
authors.affiliation: Department of Urology, Istanbul Faculty of Medicine, Istanbul University , Istanbul, Turkey .
authors.forename: Selcuk
authors.initials: S
authors.lastname: Erdem
authors.affiliation: Department of Urology, Istanbul Faculty of Medicine, Istanbul University , Istanbul, Turkey .
authors.forename: Abubekir
authors.initials: A
authors.lastname: Boyuk
authors.affiliation: Department of Urology, Istanbul Faculty of Medicine, Istanbul University , Istanbul, Turkey .
authors.forename: Tzevat
authors.initials: T
authors.lastname: Tefik
authors.affiliation: Department of Urology, Istanbul Faculty of Medicine, Istanbul University , Istanbul, Turkey .
authors.forename: Baris
authors.initials: B
authors.lastname: Yucel
authors.affiliation: Department of Urology, Istanbul Faculty of Medicine, Istanbul University , Istanbul, Turkey .
authors.forename: Rauf
authors.initials: R
authors.lastname: Naghiyev
authors.affiliation: Department of Urology, Istanbul Faculty of Medicine, Istanbul University , Istanbul, Turkey .
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ozsoy
authors.affiliation: Department of Urology, Istanbul Faculty of Medicine, Istanbul University , Istanbul, Turkey .
authors.forename: Samed
authors.initials: S
authors.lastname: Verep
authors.affiliation: Department of Urology, Istanbul Faculty of Medicine, Istanbul University , Istanbul, Turkey .
authors.forename: Oner
authors.initials: O
authors.lastname: Sanli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D048909:Diabetes Complications / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007511:Ischemia / Q000503:physiopathology; D007668:Kidney / Q000601:surgery; D007680:Kidney Neoplasms / Q000150:complications / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods*; D061646:Operative Time; D011184:Postoperative Period; D012372:ROC Curve; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology* / Q000601:surgery*; D016896:Treatment Outcome; D052096:Warm Ischemia; D055815:Young Adult