Evaluating the Effects of Different Ischaemia Techniques on Functional Outcomes of Laparoscopic Partial Nephrectomy

Abstract

Objective: This study aimed to investigate the influence of different ischaemia techniques on short-term and one year renal function following laparoscopic partial nephrectomy (LPN). Materials and Methods: Data of 359 patients who underwent LPN between November 2009 and April 2018 were reviewed, retrospectively. A total of 287 patients were included in the study. Patients were divided into 4 groups according to type of ischaemia as follows: group A (n=33) was warm ischaemia time (WIT) >20 minute, group B (n=202) was WIT <= 20 minute, group C (n=16) was selective arterial clamping and group D (n=36) was off-clamp. Demographic data, preoperative and postoperative outcomes were compared. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Change in eGFR according to group and time was evaluated using two-way analysis of variance. P values <0.05 were adopted as significant. Results: The mean tumour size was 46, 34, 36 and 25 mm (p=0.001), and operation time was 123, 92, 100 and 79 minute (p=0.001) for groups A, B, C and D, respectively. There was no need for open surgery in any of the patients. Blood loss, intraoperative and postoperative complication rates were found to be non-significantly different (p>0.05) between groups. Only 4 patients in group B had positive surgical margin. The percentage of relative eGFR (% of Delta eGFR) decline 1 year after LPN was significantly (p=0.001) higher in the ischaemic groups (A and B: 9.3% and 7.5%) compared to the zero-ischaemia groups (C and D: 5% and 3.7%). Conclusion: This study revealed that after LPN, cumulative renal function decreases to a certain extent regardless of the technique. However, it was found that cumulative renal functions are better preserved when ischaemia time is reduced to <= 20 min or eliminated.