Partial Nephrectomy: Weighing the Risks and Benefits

What is it about?

The article discusses the risks and benefits of performing partial nephrectomy with or without warm ischaemia time (WIT). The authors state that the duration of ischaemia should no longer be considered a critical clinical outcome due to its minimal impact on long-term renal function compared to other factors. The CLOCK study by Antonelli et al. is considered a cornerstone study as it was designed as a prospective experimental trial randomly allocating cases to off- or on-clamp resection, and measured renal function with scintigraphy. The study found that after accounting for baseline imbalances, patients treated with off-clamp resection had higher estimated blood loss (EBL) relative to on-clamp counterparts. However, the sample size was estimated to capture the difference in renal function among the two arms and might not be powered to properly assess the difference in secondary outcomes. The authors conclude that independent investigators from different geographical areas consistently identified a protective effect of WIT on haemorrhagic risk during partial nephrectomy, and such an observation should not be interpreted as a step back but rather as a call to offer PN candidates the safest surgery possible.

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Photo by Europeana on Unsplash

Photo by Europeana on Unsplash

Why is it important?

The research is important because it challenges the traditional belief that duration of ischaemia is a critical clinical outcome in partial nephrectomy (PN) procedures. The study finds that other factors, such as patient characteristics and comorbidities, have a greater impact on long-term renal function than ischaemia duration. Key Takeaways: 1. The study finds that duration of ischaemia should no longer be considered a critical clinical outcome in PN procedures due to its minimal impact on long-term renal function compared to other factors. 2. The CLOCK study is considered a cornerstone study as it was designed as a prospective experimental trial randomly allocating cases to off- or on-clamp resection, and its primary outcome was renal function measured with scintigraphy. 3. The study finds that patients treated with off-clamp resection had higher estimated blood loss (EBL) relative to on-clamp counterparts, but this should be interpreted with caution as the study might not be powered to properly assess difference in secondary outcomes.