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Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
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A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
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Preservation of Split Renal Function After Laparoscopic and Robot-assisted Partial Nephrectomy.

Kojiro Ohba1, Tomohiro Matsuo2, Kensuke Mitsunari1

  • 1Department of Urology and Renal Transplantation, Nagasaki University Hospital, Nagasaki, Japan.

Anticancer Research
|May 31, 2022
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Summary

Laparoscopic or robot-assisted partial nephrectomy for kidney cancer can preserve split renal function. Preoperative tumor complexity and surgical technique, specifically avoiding parenchymal suturing, predict successful outcomes.

Keywords:
Renal functionlaparoscopic partial nephrectomyparenchymal suturerobot-assisted partial nephrectomy

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Area of Science:

  • Urology
  • Nephrology
  • Surgical Oncology

Background:

  • Renal cell carcinoma (RCC) treatment often involves partial nephrectomy (PN) to preserve renal function.
  • Laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN) are common surgical approaches.
  • Assessing the impact of these techniques on split renal function is crucial for patient outcomes.

Purpose of the Study:

  • To compare the effects of LPN and RAPN on split renal function after treating renal cell carcinoma.
  • To identify factors predicting successful preservation of renal function post-nephrectomy.

Main Methods:

  • Retrospective analysis of 174 patients undergoing LPN or RAPN for RCC.
  • Evaluation of total and split renal function using 99mTc-2,3 dimercaptosuccinic acid renal imaging before and 6 months after surgery.
  • Calculation of split renal function based on estimated glomerular filtration rate (eGFR) and uptake ratios.

Main Results:

  • Robot-assisted partial nephrectomy (RAPN) was performed in 70.7% of patients.
  • A successful procedure (split eGFR >90%) was achieved in 40.2% of participants.
  • Lower RENAL nephrometry scoring system (RNS) scores, fewer external tumors, shorter warm ischemia time, RAPN, and less parenchymal suturing were associated with successful outcomes.
  • Multivariate analysis identified low RNS score and absence of parenchymal suturing as independent predictors of preserved split renal function.

Conclusions:

  • Preoperative tumor complexity (RNS score) significantly influences post-nephrectomy split renal function.
  • The surgical technique, particularly the avoidance of parenchymal suturing, is a key factor in preserving renal function after partial nephrectomy for RCC.