OncologyAssessment of Outcomes in Partial Nephrectomy Incorporating Detailed Functional Analysis
Section snippets
Materials and Methods
This study was approved by the Cleveland Clinic Institutional Review Board.
Results
Table 1 provides patient characteristics for the total cohort, which appears to be representative of conventional PN populations. Median patient age at surgery was 62 years, and 64% were male. RENAL-NS distribution included 45% with intermediate score (7-9) and 23% with high complexity score (10-12) tumors. Open surgery was performed in 82 patients (50%), and minimally invasive surgery (MIS) in 81 (49%). Cold ischemia was applied in 41% of patients (median, 27 minutes) and warm ischemia in 59%
Comment
The main objectives of PN are obtaining oncologic control, minimizing morbidity, and optimizing preservation of renal function. There are now a multitude of surgical approaches to PN, and assessment of outcomes should take all of these considerations into account. Recent focus has been on functional outcomes and efforts to avoid exacerbation of pre-existing chronic kidney disease, which can be associated with progressive decline of renal function, morbid cardiovascular events, and increased
Conclusion
Presuming careful patient selection, adequate surgical expertise, and judicious use of hypothermia, excellent outcomes can be achieved with clamped PN, whether by open or MIS approaches. A comprehensive evaluation of functional outcomes after PN, including differentiation of nephron loss vs failure to recover from ischemia, should facilitate more informative comparison of outcomes after this procedure.
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Cited by (6)
Functional Recovery from Extended Warm Ischemia Associated with Partial Nephrectomy
2016, UrologyCitation Excerpt :Corresponding median recovery from ischemia for the warm ischemia subgroups were 92%, 90%, and 91%, respectively (P = .77). Using <80% recovery from ischemia as a threshold for suboptimal recovery, which was defined a priori,18 differences were observed between the hypothermia group (6/112 = 5%) and the warm ischemia group (34/165 = 21%), suggesting more consistent recovery when hypothermia was utilized (P < .001). In contrast, duration of ischemia did not correlate with this threshold, although all such values were consistently lower in the hypothermia group (Table 2).
Financial Disclosure: The authors declare that they have no relevant financial interests.