Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
Int J Urol. 2021 Dec;28(12):1219-1225. doi: 10.1111/iju.14674. Epub 2021 Sep 1.
To evaluate the association between extended (≥30 min) warm ischemic time and renal function in patients undergoing robot-assisted partial nephrectomy.
This multi-institutional study retrospectively recruited 1131 patients who underwent robot-assisted partial nephrectomy. Patients were classified into shorter (<30 min; n = 1038) and longer (≥30 min; n = 92) groups based on the ischemic time required, and 1:2 propensity score matching was used to minimize selection bias. The perioperative outcomes, including acute kidney injury and trifecta attainment, and mid/long-term renal function were assessed before and after matching.
Patients in the longer group had tumors with a significantly larger diameter and RENAL nephrometry score. The decline in the nadir of the estimated glomerular filtration rate was significantly greater in the longer than the shorter group in the unmatched and matched cohorts (-16.2 vs -5.5%, P < 0.001; 15.5 vs -9.5%, P = 0.003, respectively). A higher incidence of acute kidney injury (9.8 vs 2.6%, P = 0.002) was observed in the longer group before matching, whereas the difference was comparable after matching. Before matching, the decline in estimated glomerular filtration rate at 6 months postoperatively was greater (-8.2 vs -5.1%, P = 0.005) and trifecta attainment was lower (50.0 vs 63.5%, P < 0.001) in the longer group. However, the differences were comparable for both the parameters between the groups in the matched cohort.
While extended warm ischemia during robot-assisted partial nephrectomy can be demanded in case of large and complex tumors, its impact on postoperative renal function is limited.
评估机器人辅助部分肾切除术患者中延长（≥30 分钟）热缺血时间与肾功能之间的关系。
这项多机构研究回顾性招募了 1131 名接受机器人辅助部分肾切除术的患者。根据缺血时间的要求，患者被分为较短（<30 分钟；n=1038）和较长（≥30 分钟；n=92）组，并使用 1:2 倾向评分匹配来最小化选择偏差。在匹配前后评估围手术期结局，包括急性肾损伤和 trifecta 实现情况，以及中/长期肾功能。
较长组的患者肿瘤直径和 RENAL 肾切除术评分明显更大。在未匹配和匹配队列中，较长组的估算肾小球滤过率的最低值下降明显大于较短组（-16.2 比-5.5%，P<0.001；15.5 比-9.5%，P=0.003）。在未匹配时，较长组的急性肾损伤发生率更高（9.8 比 2.6%，P=0.002），但匹配后差异相当。在匹配前，较长组术后 6 个月时估算肾小球滤过率的下降更大（-8.2 比-5.1%，P=0.005）， trifecta 实现率更低（50.0 比 63.5%，P<0.001）。然而，在匹配队列中，两组间这两个参数的差异相当。
虽然在大型和复杂肿瘤的情况下可能需要延长机器人辅助部分肾切除术中的热缺血时间，但它对术后肾功能的影响是有限的。
