계명대학교 의학도서관 Repository

Surgical details and renal function change after robot-assisted partial nephrectomy

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Author(s)
Teak Jun ShinCheryn SongChoung‐Soo KimHanjong Ahn
Keimyung Author(s)
Shin, Teak Jun
Department
Dept. of Urology (비뇨의학)
Journal Title
International Journal of Urology
Issued Date
2020
Volume
27
Issue
5
Keyword
detailed surgical methodsdiethylenetetramine pentaacetic acid scanrenal functionrenal tumorrobot-assisted partial nephrectomy
Abstract
Objectives:
To investigate whether differences in surgical details during robot-assisted partial nephrectomy impact postoperative renal function.

Methods:
Patient, tumor and perioperative characteristics of 751 patients who underwent robot-assisted partial nephrectomy were analyzed with respect to the difference in ipsilateral glomerular filtration rate measured by diethylenetetramine pentaacetic acid renal scan. Detailed surgical methods defined for tumor excision (cutting vs splitting), hemostasis (suturing vs clipping) and renorrhaphy (continuous vs interrupted) were analyzed for early glomerular filtration rate decline and long-term recovery.

Results:
The glomerular filtration rate of the entire cohort decreased by 9.8 mL/min/1.73 m2 (22%) at 3 months postoperatively, gradually increasing thereafter. The recovery slope was 1.7 mL/min/1.73 m2 /year during a median follow-up period of 23.0 months. Early glomerular filtration rate decline was more pronounced in the cutting group (23.5 vs 20.1%, P = 0.009). Clipping was associated with less glomerular filtration rate decline throughout the observation period, and the recovery slope was also significantly higher (2.7 vs 1.1 mL/min/1.73 m2 /year). In multivariate analysis, early decline was associated with age, preoperative glomerular filtration rate, parenchymal volume loss and ischemia >25 min. With respect to long-term recovery, suturing had the greatest adverse impact (β = -5.060, P < 0.0001, 95% confidence interval -7.709, -2.411) in addition to parenchymal volume reduction and early decline. In the propensity-matched cohort accounting for differences in tumor size and complexity, suturing was persistently associated with a significant glomerular filtration rate decline until >2 years after surgery.

Conclusions:
Hemostatic sutures during robot-assisted partial nephrectomy might interfere with long-term renal function recovery irrespective of parameters that determine the initial function change. As the splitting method reduces the use of sutures, modifying these details might help preserve renal function.
Keimyung Author(s)(Kor)
신택준
Publisher
School of Medicine (의과대학)
Citation
Teak Jun Shin et al. (2020). Surgical details and renal function change after robot-assisted partial nephrectomy. International Journal of Urology, 27(5), 457–462. doi: 10.1111/iju.14224
Type
Article
ISSN
1442-2042
Source
https://onlinelibrary.wiley.com/doi/full/10.1111/iju.14224
DOI
10.1111/iju.14224
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/43122
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Urology (비뇨의학)
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