Reevaluating Warm Ischemia Time as a Predictor of Renal Function Outcomes After Robotic Partial Nephrectomy - 26/08/18

Doi : 10.1016/j.urology.2018.06.019

Daniel C. Rosen ^a, Muthumeena Kannappan ^a, David J. Paulucci ^a, Alp Tuna Beksac ^a, Kyrollis Attalla ^a, Ronney Abaza ^b, Daniel D. Eun ^c, Akshay Bhandari ^d, Ashok K. Hemal ^e, James Porter ^f, Ketan K. Badani ^a,^⁎
^a Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
^b Robotic Urologic Surgery, OhioHealth Dublin Methodist Hospital, Columbus, OH
^c Department of Urology, Temple University School of Medicine, Philadelphia, PA
^d Division of Urology, Columbia University at Mount Sinai, Miami Beach, FL
^e Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC
^f Swedish Urology Group, Swedish Medical Center, Seattle, WA

^⁎Address correspondence to: Ketan K. Badani, Mount Sinai Health System; Mount Sinai, St. Luke's & Roosevelt Hospitals; Comprehensive Kidney Cancer Center, Mount Sinai Health System; Icahn School of Medicine, New York, NY.Mount Sinai Health System;New YorkNY

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Sunday 26 August 2018

Abstract

Objective

To explore whether variation of warm ischemia time (WIT) is associated with functional and perioperative outcomes following robotic partial nephrectomy (RPN).

Materials and Methods

Six hundred sixty eight patients, each with 2 kidneys, undergoing RPNs for a cT1 tumor were identified from a U.S. multi-institutional database. The associations between WIT, normal excisional volume loss (EVL), and surgical and renal function outcomes, including acute kidney injury at discharge and percent change in eGFR at up to 24 months post-RPN, were evaluated using Spearman's rank correlation test as well as multivariable models controlling for tumor, surgeon, and patient characteristics.

Results

WIT was weakly correlated with EVL (r = 0.32, P < .001), blood loss (r = 0.34, P < .001), and length of stay (r = 0.35, P < .001). WIT was found to be significantly associated with acute kidney injury at discharge (odds ratio = 6.23; confidence interval 1.52, 30.39). Extended WIT was not found to be significantly associated with renal function decline at 1 year post RPN (P > .05).

Conclusion

Extended WIT is associated with worse perioperative outcomes. While controlling for tumor size and EVL, effects on short-term renal function were still seen after as short as 20 minutes. Efforts to limit warm ischemia time should continue to be implemented during RPN to maximize postoperative renal function.

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Abbreviations : AKI, BMI, CCI, CKD, EBL, eGFR, EVL, ICG, MAC, MAG-3, MDRD, Off-C, PN, RIFLE, RNS, RPN, WIT

Plan

Materials and Methods

Data Source and Patient Population

Surgical Technique

Outcomes and Statistical Analyses

Results

Patients

Perioperative Variables

Acute Kidney Injury at Discharge

Long-Term Effects on eGFR Post-RPN

Discussion

Conclusion

Financial Disclosure: Dr. Eun is a lecturer for Intuitive Surgical and also a consultant for Conmed and Metronic. Dr. Abaza is a lecturer for Intuitive Surgical and also had a scientific study being conducted with Conmed, Inc. Dr. Porter is a speaker/trainer for Intuitive Surgical, Inc. and receives research support from Conmed. All of these financial conflicts of interest are unrelated to and are outside of the submitted work. All other authors have nothing to disclose.