Hori Shunta, Tomizawa Mitsuru, Onishi Kenta, Morizawa Yosuke, Gotoh Daisuke, Nakahama Tomonori, Nakai Yasushi, Miyake Makito, Yoneda Tatsuo, Tanaka Nobumichi, Fujimoto Kiyohide
Department of Urology, Nara Medical University, Nara, Japan.
Department of Prostate Brachytherapy, Nara Medical University, Nara, Japan.
In Vivo. 2025 May-Jun;39(3):1554-1566. doi: 10.21873/invivo.13955.
BACKGROUND/AIM: This study aimed to explore factors related to residual renal function in patients with small renal tumors treated with robot-assisted partial nephrectomy.
This retrospective study included 188 patients with two functioning kidneys who were diagnosed with localized renal tumors and underwent robot-assisted partial nephrectomy using the clamping technique. The residual renal function 12 months after the surgery was evaluated in two ways: >90% preservation of the estimated glomerular filtration rate and no stage progression of chronic kidney disease.
The median age, body mass index, and warm ischemic time were 68 years, 23.3 kg/m, and 19 min, respectively. Ten patients were diagnosed with positive surgical margins. Multivariate analysis revealed no significant preoperative factors, including renal function. Among surgical factors, warm ischemic time was an independent factor for chronic kidney disease progression, whereas it showed no significant association with the preservation of residual renal function ( =0.042 and p=0.14, respectively). Early recovery, defined as the difference in estimated glomerular filtration rate before and three months post-surgery, independently correlated with poor residual renal function preservation and chronic kidney disease progression (<0.0001 and <0.0001, respectively). Furthermore, no significant difference was observed in residual renal function recovery between warm ischemic time <25 and ≥25 min (=0.58).
Early recovery from residual renal function was crucial for preserving residual renal function and preventing chronic kidney disease progression after surgery. Understanding the factors influencing residual renal function preservation might lead to the optimization of treatment strategies in current clinical practice.
背景/目的：本研究旨在探讨接受机器人辅助部分肾切除术的小肾肿瘤患者残余肾功能的相关因素。
本回顾性研究纳入了188例双肾功能正常、被诊断为局限性肾肿瘤并采用阻断技术接受机器人辅助部分肾切除术的患者。术后12个月的残余肾功能通过两种方式进行评估：估计肾小球滤过率保留>90%以及慢性肾脏病无分期进展。
中位年龄、体重指数和热缺血时间分别为68岁、23.3kg/m²和19分钟。10例患者被诊断为手术切缘阳性。多因素分析显示，包括肾功能在内的术前因素均无显著意义。在手术因素中，热缺血时间是慢性肾脏病进展的独立因素，而其与残余肾功能的保留无显著关联（分别为 =0.042和p=0.14）。早期恢复定义为术前与术后三个月估计肾小球滤过率的差值，其与残余肾功能保留不佳和慢性肾脏病进展独立相关（分别<0.0001和<0.0001）。此外，热缺血时间<25分钟和≥25分钟之间的残余肾功能恢复无显著差异（ =0.58）。
残余肾功能的早期恢复对于术后保留残余肾功能和预防慢性肾脏病进展至关重要。了解影响残余肾功能保留的因素可能有助于优化当前临床实践中的治疗策略。
