Predictors of unilateral renal function after open and laparoscopic partial nephrectomy

Area of Science:

• Nephrology
• Urology
• Surgical Oncology

Background:

• Partial nephrectomy is a key procedure for kidney preservation.
• Accurate prediction of postoperative renal function is crucial for patient management.
• Laparoscopic and open approaches have different potential impacts on renal function.

Purpose of the Study:

• To identify predictors of postoperative unilateral renal function after partial nephrectomy.
• To evaluate clinical, tumor, and surgical factors influencing ipsilateral kidney function.
• To compare predictive factors between laparoscopic and open partial nephrectomy.

Main Methods:

• Retrospective analysis of 65 patients undergoing partial nephrectomy.
• Evaluation of factors including patient age, surgical approach, tumor characteristics, and ischemia time.
• Correlation of these factors with differential renal function measured by technetium-99m-mercaptoacetyltriglycine renal scintigraphy.

Main Results:

• Intraoperative visual estimation of preserved renal parenchyma volume was the strongest predictor (P <.001).
• Tumor size (radiologic and pathologic) and procedure type (laparoscopic vs. open) were also significant predictors (P = .017, P = .041, P = .021, respectively).
• Tumor depth showed borderline significance (P = .050); multivariate analysis did not identify joint prognostic factors.

Conclusions:

• Intraoperative visual estimation of functioning residual renal volume is the most accurate predictor of postoperative unilateral renal function.
• Tumor depth has intermediate prognostic value for estimating postoperative split renal function.
• Routine documentation of intraoperative visual estimation of preserved renal parenchyma volume is recommended for both laparoscopic and open partial nephrectomy.