Kyle A Blum1, David J Paulucci1, Ronney Abaza2, Daniel D Eun3, Akshay Bhandari4, Joan C Delto4, Louis S Krane5, Ashok K Hemal5, Ketan K Badani6. 1. Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY. 2. Robotic Urologic Surgery, OhioHealth Dublin Methodist Hospital, Columbus, OH. 3. Temple University School of Medicine, Philadelphia, PA. 4. Division of Urology, Columbia University at Mount Sinai, Miami Beach, FL. 5. Wake Forest School of Medicine, Winston-Salem, NC. 6. Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY. Electronic address: Ketan.Badani@mountsinai.org.
Abstract
OBJECTIVE: To compare renal function outcome between a contemporary cohort of propensity score-matched patients undergoing main renal artery clamping (MAC) alone and those undergoing main renal artery clamping with renal vein clamping (MVAC) during robotic partial nephrectomy. MATERIALS AND METHODS: Patients with a solitary T1 renal mass undergoing robotic partial nephrectomy were propensity score-matched on American Society of Anesthesiologists score, RENAL Nephrometry score, tumor size, tumor laterality, and operating surgeon to provide 66 patients undergoing MAC and 66 patients undergoing MVAC for analysis. Demographic and tumor-specific characteristics in addition to perioperative and renal function outcomes at discharge and 9 months were compared. RESULTS: No differences in any baseline characteristics including age (P = .847), baseline estimated glomerular filtration rate (eGFR) (P = .358), RENAL Nephrometry score (P = .617), and tumor size (P = .551) were identified. Warm ischemia time was longer in patients undergoing MVAC than in patients undergoing MAC (21.0 minutes vs 15.0, P <.001), with no differences in estimated blood loss (P = .413), length of hospitalization (P = .112), and postoperative complications (overall [P = .251], by Clavien-Dindo classification [P = .119]). No differences in the percent change in eGFR (P = .866) or acute kidney injury (P = .493) at discharge and no differences in the percent change in eGFR (P = .401) or progression to chronic kidney disease (P = .594) at 9 months were identified. CONCLUSION: Compared with MAC, clamping of the renal vein in addition to the main renal artery does not appear to adversely affect postoperative renal function. Future studies comparing MAC with MVAC partial nephrectomy in patients with baseline chronic kidney disease, a solitary kidney and complex tumors with prolonged warm ischemia time are necessary.
OBJECTIVE: To compare renal function outcome between a contemporary cohort of propensity score-matched patients undergoing main renal artery clamping (MAC) alone and those undergoing main renal artery clamping with renal vein clamping (MVAC) during robotic partial nephrectomy. MATERIALS AND METHODS:Patients with a solitary T1 renal mass undergoing robotic partial nephrectomy were propensity score-matched on American Society of Anesthesiologists score, RENAL Nephrometry score, tumor size, tumor laterality, and operating surgeon to provide 66 patients undergoing MAC and 66 patients undergoing MVAC for analysis. Demographic and tumor-specific characteristics in addition to perioperative and renal function outcomes at discharge and 9 months were compared. RESULTS: No differences in any baseline characteristics including age (P = .847), baseline estimated glomerular filtration rate (eGFR) (P = .358), RENAL Nephrometry score (P = .617), and tumor size (P = .551) were identified. Warm ischemia time was longer in patients undergoing MVAC than in patients undergoing MAC (21.0 minutes vs 15.0, P <.001), with no differences in estimated blood loss (P = .413), length of hospitalization (P = .112), and postoperative complications (overall [P = .251], by Clavien-Dindo classification [P = .119]). No differences in the percent change in eGFR (P = .866) or acute kidney injury (P = .493) at discharge and no differences in the percent change in eGFR (P = .401) or progression to chronic kidney disease (P = .594) at 9 months were identified. CONCLUSION: Compared with MAC, clamping of the renal vein in addition to the main renal artery does not appear to adversely affect postoperative renal function. Future studies comparing MAC with MVAC partial nephrectomy in patients with baseline chronic kidney disease, a solitary kidney and complex tumors with prolonged warm ischemia time are necessary.