Factors affecting renal function after open partial nephrectomy - A comparison of clampless and clamped warm ischemic technique

Ryan P. Kopp, Reza Mehrazin, Kerrin Palazzi, Wassim M. Bazzi, Anthony Patterson, Ithaar H. Derweesh

Research output: Contribution to journalArticle

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Abstract

Objective: To analyze factors impacting postoperative renal function after open partial nephrectomy using both the clampless and clamped warm-ischemic technique. Methods: We studied a cohort of patients who underwent clamped partial nephrectomy (n = 164) and clampless partial nephrectomy (n = 64) from March 2002 to March 2009 with <12-months follow-up. Clamped partial nephrectomy used hilar occlusion before resection. Clampless partial nephrectomy used focal radio frequency coagulation to facilitate hemostasis before resection, nonischemic dissection/resection with hydro-dissection, or sharp resection after local compression. Demographics, tumor characteristics/RENAL nephrometry scores, perioperative variables, and complications were compared between the two methods. Multivariable analysis was performed to identify factors predicting de novo estimated glomerular filtration rate <60. Results: Patient characteristics were similar between groups. Mean RENAL score was greater in clamped (6.9) vs clampless (6.4, P =.026); complications (P =.430) and urine leaks (clampless partial nephrectomy 3.1% vs clamped-PN 7.3%, P =.360) were similar. Mean warm ischemia time (min) was 24.5 for clamped partial nephrectomy. De novo estimated glomerular filtration rate <60(%) at last follow up was 13.5 (clamped) vs 3.1 (clampless) (P =.071). Multivariable analysis of the entire cohort revealed increasing body mass index (OR 1.1, P =.042) and RENAL score (OR 1.71, P =.002) as being independently associated with development of postoperative de novo estimated glomerular filtration rate <60. Multivariable analysis of the clamped subgroup demonstrated increasing body mass index (OR 1.12, P =.028), RENAL score (OR 1.56, P =.010), and ischemia time (OR 1.15, P =.042) as independent factors associated with de novo estimated glomerular filtration rate <60. Conclusion: Body mass index and RENAL score were factors predictive of development of de novo estimated glomerular filtration rate <60 after partial nephrectomy, with increasing warm ischemia time also being predictive in clamped partial nephrectomy patients. Further investigation and long-term functional data are requisite.

Original languageEnglish (US)
Pages (from-to)865-871
Number of pages7
JournalUrology
Volume80
Issue number4
DOIs
StatePublished - Jan 1 2012

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Nephrectomy
Kidney
Glomerular Filtration Rate
Warm Ischemia
Body Mass Index
Dissection
Hemostasis
Radio
Statistical Factor Analysis
Cohort Studies
Ischemia
Demography
Urine

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Factors affecting renal function after open partial nephrectomy - A comparison of clampless and clamped warm ischemic technique. / Kopp, Ryan P.; Mehrazin, Reza; Palazzi, Kerrin; Bazzi, Wassim M.; Patterson, Anthony; Derweesh, Ithaar H.

In: Urology, Vol. 80, No. 4, 01.01.2012, p. 865-871.

Research output: Contribution to journalArticle

Kopp, Ryan P. ; Mehrazin, Reza ; Palazzi, Kerrin ; Bazzi, Wassim M. ; Patterson, Anthony ; Derweesh, Ithaar H. / Factors affecting renal function after open partial nephrectomy - A comparison of clampless and clamped warm ischemic technique. In: Urology. 2012 ; Vol. 80, No. 4. pp. 865-871.
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abstract = "Objective: To analyze factors impacting postoperative renal function after open partial nephrectomy using both the clampless and clamped warm-ischemic technique. Methods: We studied a cohort of patients who underwent clamped partial nephrectomy (n = 164) and clampless partial nephrectomy (n = 64) from March 2002 to March 2009 with <12-months follow-up. Clamped partial nephrectomy used hilar occlusion before resection. Clampless partial nephrectomy used focal radio frequency coagulation to facilitate hemostasis before resection, nonischemic dissection/resection with hydro-dissection, or sharp resection after local compression. Demographics, tumor characteristics/RENAL nephrometry scores, perioperative variables, and complications were compared between the two methods. Multivariable analysis was performed to identify factors predicting de novo estimated glomerular filtration rate <60. Results: Patient characteristics were similar between groups. Mean RENAL score was greater in clamped (6.9) vs clampless (6.4, P =.026); complications (P =.430) and urine leaks (clampless partial nephrectomy 3.1{\%} vs clamped-PN 7.3{\%}, P =.360) were similar. Mean warm ischemia time (min) was 24.5 for clamped partial nephrectomy. De novo estimated glomerular filtration rate <60({\%}) at last follow up was 13.5 (clamped) vs 3.1 (clampless) (P =.071). Multivariable analysis of the entire cohort revealed increasing body mass index (OR 1.1, P =.042) and RENAL score (OR 1.71, P =.002) as being independently associated with development of postoperative de novo estimated glomerular filtration rate <60. Multivariable analysis of the clamped subgroup demonstrated increasing body mass index (OR 1.12, P =.028), RENAL score (OR 1.56, P =.010), and ischemia time (OR 1.15, P =.042) as independent factors associated with de novo estimated glomerular filtration rate <60. Conclusion: Body mass index and RENAL score were factors predictive of development of de novo estimated glomerular filtration rate <60 after partial nephrectomy, with increasing warm ischemia time also being predictive in clamped partial nephrectomy patients. Further investigation and long-term functional data are requisite.",
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T1 - Factors affecting renal function after open partial nephrectomy - A comparison of clampless and clamped warm ischemic technique

AU - Kopp, Ryan P.

AU - Mehrazin, Reza

AU - Palazzi, Kerrin

AU - Bazzi, Wassim M.

AU - Patterson, Anthony

AU - Derweesh, Ithaar H.

PY - 2012/1/1

Y1 - 2012/1/1

N2 - Objective: To analyze factors impacting postoperative renal function after open partial nephrectomy using both the clampless and clamped warm-ischemic technique. Methods: We studied a cohort of patients who underwent clamped partial nephrectomy (n = 164) and clampless partial nephrectomy (n = 64) from March 2002 to March 2009 with <12-months follow-up. Clamped partial nephrectomy used hilar occlusion before resection. Clampless partial nephrectomy used focal radio frequency coagulation to facilitate hemostasis before resection, nonischemic dissection/resection with hydro-dissection, or sharp resection after local compression. Demographics, tumor characteristics/RENAL nephrometry scores, perioperative variables, and complications were compared between the two methods. Multivariable analysis was performed to identify factors predicting de novo estimated glomerular filtration rate <60. Results: Patient characteristics were similar between groups. Mean RENAL score was greater in clamped (6.9) vs clampless (6.4, P =.026); complications (P =.430) and urine leaks (clampless partial nephrectomy 3.1% vs clamped-PN 7.3%, P =.360) were similar. Mean warm ischemia time (min) was 24.5 for clamped partial nephrectomy. De novo estimated glomerular filtration rate <60(%) at last follow up was 13.5 (clamped) vs 3.1 (clampless) (P =.071). Multivariable analysis of the entire cohort revealed increasing body mass index (OR 1.1, P =.042) and RENAL score (OR 1.71, P =.002) as being independently associated with development of postoperative de novo estimated glomerular filtration rate <60. Multivariable analysis of the clamped subgroup demonstrated increasing body mass index (OR 1.12, P =.028), RENAL score (OR 1.56, P =.010), and ischemia time (OR 1.15, P =.042) as independent factors associated with de novo estimated glomerular filtration rate <60. Conclusion: Body mass index and RENAL score were factors predictive of development of de novo estimated glomerular filtration rate <60 after partial nephrectomy, with increasing warm ischemia time also being predictive in clamped partial nephrectomy patients. Further investigation and long-term functional data are requisite.

AB - Objective: To analyze factors impacting postoperative renal function after open partial nephrectomy using both the clampless and clamped warm-ischemic technique. Methods: We studied a cohort of patients who underwent clamped partial nephrectomy (n = 164) and clampless partial nephrectomy (n = 64) from March 2002 to March 2009 with <12-months follow-up. Clamped partial nephrectomy used hilar occlusion before resection. Clampless partial nephrectomy used focal radio frequency coagulation to facilitate hemostasis before resection, nonischemic dissection/resection with hydro-dissection, or sharp resection after local compression. Demographics, tumor characteristics/RENAL nephrometry scores, perioperative variables, and complications were compared between the two methods. Multivariable analysis was performed to identify factors predicting de novo estimated glomerular filtration rate <60. Results: Patient characteristics were similar between groups. Mean RENAL score was greater in clamped (6.9) vs clampless (6.4, P =.026); complications (P =.430) and urine leaks (clampless partial nephrectomy 3.1% vs clamped-PN 7.3%, P =.360) were similar. Mean warm ischemia time (min) was 24.5 for clamped partial nephrectomy. De novo estimated glomerular filtration rate <60(%) at last follow up was 13.5 (clamped) vs 3.1 (clampless) (P =.071). Multivariable analysis of the entire cohort revealed increasing body mass index (OR 1.1, P =.042) and RENAL score (OR 1.71, P =.002) as being independently associated with development of postoperative de novo estimated glomerular filtration rate <60. Multivariable analysis of the clamped subgroup demonstrated increasing body mass index (OR 1.12, P =.028), RENAL score (OR 1.56, P =.010), and ischemia time (OR 1.15, P =.042) as independent factors associated with de novo estimated glomerular filtration rate <60. Conclusion: Body mass index and RENAL score were factors predictive of development of de novo estimated glomerular filtration rate <60 after partial nephrectomy, with increasing warm ischemia time also being predictive in clamped partial nephrectomy patients. Further investigation and long-term functional data are requisite.

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