Partial Nephrectomy: Weighing the Risks and Benefits of Zero Ischaemia Time

What is it about?

This study investigates the relationship between warm ischemia time (WIT) and renal functional outcomes after partial nephrectomy (PN). Data from 1140 patients were collected, with WIT defined as the duration of clamping of the main renal artery. Longer WIT was associated with decreased postoperative estimated glomerular filtration rate (eGFR), but no association was found at 6-month or long-term follow-up. No correlation was found between WIT and positive surgical margin status. The study suggests that performing PN with very limited or zero WIT might increase bleeding and the need for peri-operative transfusion while not improving long-term renal function outcomes. The findings support the hypothesis that WIT is not the most important determinant of long-term renal function impairment after PN.

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Photo by Europeana on Unsplash

Photo by Europeana on Unsplash

Why is it important?

This research is important because it provides evidence-based findings on the role of warm ischemia time (WIT) during partial nephrectomy (PN) surgery in preserving renal function and reducing surgery-related morbidity. These findings can help patients and clinicians make informed decisions about the best surgical approach for individual cases. Key Takeaways: 1. WIT is not the most important determinant of long-term renal function impairment after PN. 2. Longer WIT was associated with decreased postoperative eGFR, but no association was recorded at 6-month or long-term follow-up. 3. Performing zero-ischemia PN may increase bleeding and the need for peri-operative transfusion while not improving long-term renal function outcomes. 4. Clinicians should consider intra-operative decision-making factors such as patient comorbidities, tumour characteristics, and surgical experience when choosing between clamping and no-clamp techniques during PN. 5. New techniques in renorrhaphy can facilitate intracorporeal suturing during PN, minimizing WIT and EBL, which can help optimize surgical features and preserve renal function.