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Are warm ischemia and ischemia time still predictive factors of poor renal function after partial nephrectomy in the setting of elective indication?

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Abstract

Purpose

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.

Conclusion

Non- or time-limited clamping techniques are associated with preservation of renal function in the elective indications setting of NSS.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical standard

The study and database have been approved by every institutional review board and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Author information

Authors and Affiliations

  1. Department of Urology, Bicêtre University Hospital, Le Kremlin Bicêtre, France

    Thomas Bessede, Geraldine Pignot, Fabien Boulière & Jean-Jacques Patard

  2. Department of Urology, Angers University Hospital, 5 rue Larrey, 49100, Angers, France

    Pierre Bigot

  3. Department of Urology, Pellegrin University Hospital, Bordeaux, France

    Jean-Christophe Bernhard & Jean-Marie Ferrière

  4. Department of Urology, Pontchaillou University Hospital, Rennes, France

    Gregory Verhoest, Maxime Crépel & Karim Bensalah

  5. Department of Urology, Mondor University Hospital, Paris, France

    Laurent Salomon

  6. Department of Urology, Saint Etienne University Hospital, Saint-Étienne, France

    Nicolas Mottet

  7. Department of Urology, Toulouse University Hospital, Toulouse, France

    Laurent Bellec & Michel Soulié

  8. Department of Urology, Charles Nicolle University Hospital, Rouen, France

    Christian Pfister & Baptiste Albouy

  9. Department of Urology, Laval, QC, Canada

    Frederic Pouliot & Thierry Dujardin

Authors
  1. Thomas Bessede
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  2. Pierre Bigot
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  3. Jean-Christophe Bernhard
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  18. Jean-Jacques Patard
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Corresponding author

Correspondence to Pierre Bigot.

Additional information

Thomas Bessede and Pierre Bigot have contributed equally to this work.

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Bessede, T., Bigot, P., Bernhard, JC. et al. Are warm ischemia and ischemia time still predictive factors of poor renal function after partial nephrectomy in the setting of elective indication?. World J Urol 33, 11–15 (2015). https://doi.org/10.1007/s00345-014-1292-7

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  • DOI: https://doi.org/10.1007/s00345-014-1292-7

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