Renoprotective Procedures with a Cold Ischemia Time of <60 min Minimize the Deterioration of Kidney Function in Open Nephron-Sparing Surgery for Renal Cell Carcinoma

Urol Int. 2017;99(3):283-289. doi: 10.1159/000479037. Epub 2017 Jul 20.

Abstract

Introduction: We evaluated whether nephron sparing surgery (NSS) combined with meticulous suturing of the cut stump under clamping with cooling is beneficial for oncological outcomes and also assessed the relationship between cold ischemia time and deterioration of renal function.

Methods: One hundred and six patients with renal cell carcinoma (RCC) were subjected to this procedure. Oncological outcomes and renal function according to the estimated glomerular filtration rate (eGFR) and the tubular excretion rate on renoscintigraphy before and at 12 months after surgery were evaluated.

Results: Cancer recurrences were observed in 2 patients with past history of RCC; however, no patient died of cancer. Renal function was evaluated depending on 4 different ischemia times. All groups did not show a remarkable decrease of renal function in terms of eGFR. Renoscintigraphy revealed the deterioration of the affected kidney in patients with >60 min ischemia.

Conclusion: The renoprotective procedure of NSS provided maximum preservation of renal function until 60 min of cold ischemia time.

Keywords: Cold ischemia time; Nephron-sparing surgery; Renal cell carcinoma; Renal function; Ultrasonic scalpel.

MeSH terms

  • Adult
  • Aged
  • Carcinoma, Renal Cell / diagnostic imaging
  • Carcinoma, Renal Cell / pathology
  • Carcinoma, Renal Cell / physiopathology
  • Carcinoma, Renal Cell / surgery*
  • Cold Ischemia* / adverse effects
  • Female
  • Glomerular Filtration Rate*
  • Humans
  • Kidney / diagnostic imaging
  • Kidney / pathology
  • Kidney / physiopathology
  • Kidney / surgery*
  • Kidney Neoplasms / diagnostic imaging
  • Kidney Neoplasms / pathology
  • Kidney Neoplasms / physiopathology
  • Kidney Neoplasms / surgery*
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Nephrectomy / adverse effects
  • Nephrectomy / methods*
  • Nephrons / pathology
  • Nephrons / physiopathology*
  • Recovery of Function
  • Retrospective Studies
  • Risk Factors
  • Suture Techniques
  • Time Factors
  • Treatment Outcome