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International Urology and Nephrology

, Volume 48, Issue 5, pp 687–693 | Cite as

Comparison of renal functional outcomes in exactly matched pairs between robot-assisted partial nephrectomy using warm ischemia and open partial nephrectomy using cold ischemia using diethylene triamine penta-acetic acid renal scintigraphy

  • Sangjun Yoo
  • Chanwoo Lee
  • Chunwoo Lee
  • Dalsan You
  • In Gab Jeong
  • Choung-Soo KimEmail author
Urology - Original Paper

Abstract

Purpose

To compare renal functional outcomes in patients with a small renal mass undergoing robot-assisted partial nephrectomy using warm ischemia (wRAPN) or open partial nephrectomy using cold ischemia (cOPN).

Methods

This study included 185 patients who underwent partial nephrectomy and were assessed by preoperative and postoperative diethylene triamine penta-acetic acid renal scintigraphy. Variables associated with postoperative operated-side glomerular filtration rate decrement (ΔGFR) were assessed using multivariate analysis. Exact 1:1 propensity score matching was performed using variables related to ΔGFR. Furthermore, 30 patients who underwent wRAPN were matched with 30 patients who underwent cOPN, and their differences in ΔGFR were calculated.

Results

Patients who underwent cOPN were older (p = 0.025) and had shorter ischemia time (p < 0.001) than patients who underwent wRAPN. Multivariate analysis showed that surgical method, preoperative operated-side GFR and RENAL nephrometry score were significantly associated with operated-side ΔGFR. After propensity score matching, postoperative 3-month (14.8 vs. 7.3 mL/min/1.73 m2, p = 0.057) and 1-year operated-side ΔGFR (11.4 vs. 2.8 mL/min/1.73 m2, p = 0.031) was higher after wRAPN than after cOPN in patients with ischemia time ≥25 min, but did not differ in patients with ischemia time <25 min. Within the matched pairs, cOPN resulted in lower operated-side ΔGFR than wRAPN in patients with ischemia time ≥25 min (−6.9 mL/min/1.73 m2, p = 0.047). Moreover, total GFR decrement was slightly lower with cOPN than with wRAPN (−7.2 mL/min/1.73 m2, p = 0.086).

Conclusions

cOPN was superior to wRAPN in patients with a small renal mass and ischemia time ≥25 min. However, wRAPN yielded renal functional outcomes comparable to those of cOPN when ischemia time was <25 min.

Keywords

Nephrectomy Glomerular filtration rate Warm ischemia Cold ischemia 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  • Sangjun Yoo
    • 1
  • Chanwoo Lee
    • 1
  • Chunwoo Lee
    • 1
  • Dalsan You
    • 1
  • In Gab Jeong
    • 1
  • Choung-Soo Kim
    • 1
    Email author
  1. 1.Department of Urology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea

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