Multivariate analysis of the factors involved in loss of renal differential function after laparoscopic partial nephrectomy: a role for warm ischemia time

Authors

  • Frédéric Pouliot Institute of Urologic Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA
  • Allan Pantuck Institute of Urologic Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA
  • Annie Imbeault Centre Hospitalier Universitaire de Québec, Université Laval, Québec, QC
  • Brian Shuch Institute of Urologic Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA
  • Brian Calimlim Institute of Urologic Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA
  • Jean-François Audet Centre Hospitalier Universitaire de Québec, Université Laval, Québec, QC
  • David S. Finley Centre Hospitalier Universitaire de Québec, Université Laval, Québec, QC
  • Thierry Dujardin Centre Hospitalier Universitaire de Québec, Université Laval, Québec, QC

DOI:

https://doi.org/10.5489/cuaj.588

Abstract

Background: Partial nephrectomy (PN) is now the gold standard
for the surgical treatment of small renal masses. We evaluated the
effect of WIT and other factors on RDF assessed by preoperative
and postoperative renal scintigraphy.

Methods: Between 2003 and 2008, 182 consecutive laparoscopic
PN (LPN) were performed in an academic centre. Among those,
56 had mercaptoacetyl triglycine (MAG3) lasix renal scintigraphy
preoperatively and postoperatively.

Results: Medians for age, preoperative estimated glomerular filtration
rate and computed tomography scan tumour size were 62
years, 82 mL/min/1.73m2 and 26 mm, respectively. Median WIT
and preoperative RDF were 30 minutes and 50%, respectively.
Median loss of RDF after surgery was 14%. Linear regression curves
showed that loss in RDF rate was 0.2% per minute when WIT was
<30 minutes and 0.7% per minute when WIT was ≥30 minutes.
In multivariate analysis, length of WIT and endophytic tumour
location were associated with a statistically significant loss of RDF
(p < 0.05), but only in the group who experienced >30 minutes
of WIT.

Interpretation: Our results suggest that the factors associated with
loss of RDF are not the same before and after 30 minutes of WIT
and that the rate of loss in RDF increases after 30 minutes. Since,
the effect of WIT is small up to 30 minutes, we believe that surgery
should focus on limiting the resection of normal parenchyma
and to ensure negative margins and hemostasis, rather than on
premature unclamping.

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Author Biographies

Frédéric Pouliot, Institute of Urologic Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA

Allan Pantuck, Institute of Urologic Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA

Annie Imbeault, Centre Hospitalier Universitaire de Québec, Université Laval, Québec, QC

Brian Shuch, Institute of Urologic Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA

Brian Calimlim, Institute of Urologic Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA

Jean-François Audet, Centre Hospitalier Universitaire de Québec, Université Laval, Québec, QC

David S. Finley, Centre Hospitalier Universitaire de Québec, Université Laval, Québec, QC

Thierry Dujardin, Centre Hospitalier Universitaire de Québec, Université Laval, Québec, QC

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How to Cite

Pouliot, F., Pantuck, A., Imbeault, A., Shuch, B., Calimlim, B., Audet, J.-F., Finley, D. S., & Dujardin, T. (2013). Multivariate analysis of the factors involved in loss of renal differential function after laparoscopic partial nephrectomy: a role for warm ischemia time. Canadian Urological Association Journal, 5(2), 89–95. https://doi.org/10.5489/cuaj.588

Issue

Vol. 5 No. 2 (2011): April

Section

Original Research

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