Does Prolonged Warm Ischemia After Partial Nephrectomy Under Pneumoperitoneum Cause Irreversible Damage to the Affected Kidney?

作者：Choi Jae Duck; Park Jong Wook; Lee Seo Yeon; Jeong Byong Chang; Jeon Seong Soo; Lee Hyun Moo; Choi Han Yong; Il Seo Seong^*

来源：Journal of Urology, 2012, 187(3): 802-806.

DOI：10.1016/j.juro.2011.10.140

• nephrectomy
• warm ischemia
• radionuclide imaging
• robotics

Purpose: We determined the effects of warm ischemia time on the recovery of renal function after partial nephrectomy under pneumoperitoneum. %26lt;br%26gt;Materials and Methods: In this prospective study 37 consecutive patients who underwent laparoscopic partial nephrectomy or robot-assisted partial nephrectomy between June 2008 and May 2009 to remove a single cT1 renal tumor were evaluated using Tc-99m-diethylenetriamine pentaacetic acid renal scintigraphy preoperatively, and at 3 and 12 months postoperatively. %26lt;br%26gt;Results: The most significant reduction in the glomerular filtration rate of the affected kidney at 3 and 12 months after surgery (p = 0.018, p = 0.036, respectively) was seen for a warm ischemia time cutoff of 28 minutes. The glomerular filtration rate of the affected kidney was consistently and significantly reduced at 3 and 12 months postoperatively (-22.4% to -30.6%, p %26lt;0.001) in patients with a warm ischemia time greater than 28 minutes. In contrast, no significant glomerular filtration rate change was seen in patients with a warm ischemia time of 28 minutes or less. In terms of the contributional change of the affected kidney to total renal function, there is a trend toward a recovery after an initial decrease in both groups with a warm ischemia time greater than 28 minutes vs 28 minutes or less. On multivariate analysis warm ischemia time was a strong independent predictor of glomerular filtration rate reduction even 12 months after surgery (beta = -1.3; 95% CI -1.8, -0.7; p %26lt;0.001). %26lt;br%26gt;Conclusions: If the warm ischemia time is greater than 28 minutes during laparoscopic partial nephrectomy or robot-assisted partial nephrectomy, the functional damage to the affected kidney progresses even up to 1 year after surgery.

• 出版日期2012-3