Mp67-07 Risks and Benefits of Partial Nephrectomy With Limited or Without Ischemia Time in the Extreme Scenario of Patients With a Solitary Kidney

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy V (MP67)1 May 2024MP67-07 RISKS AND BENEFITS OF PARTIAL NEPHRECTOMY WITH LIMITED OR WITHOUT ISCHEMIA TIME IN THE EXTREME SCENARIO OF PATIENTS WITH A SOLITARY KIDNEY Francesco Cei, Daniele Cignoli, Andrea Minervini, Andrea Mari, Fabrizio Di Maida, Karim Bensalah, Benoit Peyronnet, Riccardo Schiavina, Lorenzo Bianchi, Alexandre Mottrie, Geert De Naeyer, Ruben De Groote, Alessandro Antonelli, Riccardo Bertolo, Koon Ho Rha, Ahmad Almujalhem, Ithaar Derweesh, Aaron W. Bradshaw, Jihad Kaouk, Guilherme V. Sawczyn, Alberto Breda, Umberto Capitanio, Francesco Montorsi, and Alessandro Larcher Francesco CeiFrancesco Cei , Daniele CignoliDaniele Cignoli , Andrea MinerviniAndrea Minervini , Andrea MariAndrea Mari , Fabrizio Di MaidaFabrizio Di Maida , Karim BensalahKarim Bensalah , Benoit PeyronnetBenoit Peyronnet , Riccardo SchiavinaRiccardo Schiavina , Lorenzo BianchiLorenzo Bianchi , Alexandre MottrieAlexandre Mottrie , Geert De NaeyerGeert De Naeyer , Ruben De GrooteRuben De Groote , Alessandro AntonelliAlessandro Antonelli , Riccardo BertoloRiccardo Bertolo , Koon Ho RhaKoon Ho Rha , Ahmad AlmujalhemAhmad Almujalhem , Ithaar DerweeshIthaar Derweesh , Aaron W. BradshawAaron W. Bradshaw , Jihad KaoukJihad Kaouk , Guilherme V. SawczynGuilherme V. Sawczyn , Alberto BredaAlberto Breda , Umberto CapitanioUmberto Capitanio , Francesco MontorsiFrancesco Montorsi , and Alessandro LarcherAlessandro Larcher View All Author Informationhttps://doi.org/10.1097/01.JU.0001009496.54470.10.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Growing evidence suggests that ischemia time IT has far less influence on postoperative renal function compared to other factors. However, the information available on the trade-off for risk and benefit of IT on long-term renal function in case patients with solitary kidney SK elected for partial nephrectomy PN is scarce. Accordingly, the aim of the study is to evaluate the potential benefit and harms of no or limited IT during PN in patients with solitary kidney. METHODS: This study included 244 single-kidney patients treated with elective PN for a single cT1–2N0M0 renal mass at nine high-volume European, North American, and Asian institutions. IT was defined as the duration of clamping of the main renal artery. The primary outcome of the study was postoperative, 1-year and long-term renal function defined as estimated glomerular filtration rate eGFR. The secondary outcome of the study were estimated blood loss EBL and perioperative transfusions. We relied on linear, logistic and Cox regression analysis MVA accounting for age, comorbidities, clinical size, preoperative eGFR and year of surgery to assess the impact of IT on the study outcomes. RESULTS: Off-clamp PN was performed in 127 patients (52%). The median duration of IT for patients treated with on-clamp strategy was 18 minutes. At MVA predicting renal function, longer IT resulted associated with decreased postoperative eGFR (Est -0.37; p=0.03). Conversely, no association between IT and eGFR was recorded at 1 year (Est -0.04; p=0.7) or at long term follow-up (Est -0.28; p=0.07). At MVA predicting hemorrhagic risk, IT resulted associated with EBL (Est -6.16; p=0.04) and perioperative transfusion (OR 0.99; p=0.01; Figures 1A-1B). CONCLUSIONS: In SK patients, performing off-clamp PN is associated with improved renal function at short term assessment only and at long term follow-up, any advantage relative to on-clamp PN phases out. Conversely, off-clamp PN increases hemorrhagic risk. These findings support hilum preparation and on-clamp PN even in the extreme scenario of SK patients. Despite being the largest cohort of SK patients available to date, our conclusions may require further validation through larger sample sizes and even longer IT to confirm the hypothesis of a neutral impact of IT on renal function. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1099 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Francesco Cei More articles by this author Daniele Cignoli More articles by this author Andrea Minervini More articles by this author Andrea Mari More articles by this author Fabrizio Di Maida More articles by this author Karim Bensalah More articles by this author Benoit Peyronnet More articles by this author Riccardo Schiavina More articles by this author Lorenzo Bianchi More articles by this author Alexandre Mottrie More articles by this author Geert De Naeyer More articles by this author Ruben De Groote More articles by this author Alessandro Antonelli More articles by this author Riccardo Bertolo More articles by this author Koon Ho Rha More articles by this author Ahmad Almujalhem More articles by this author Ithaar Derweesh More articles by this author Aaron W. Bradshaw More articles by this author Jihad Kaouk More articles by this author Guilherme V. Sawczyn More articles by this author Alberto Breda More articles by this author Umberto Capitanio More articles by this author Francesco Montorsi More articles by this author Alessandro Larcher More articles by this author Expand All Advertisement PDF downloadLoading ...