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Impact Of Renal Arterial Occlusion On Postoperative Renal Function FollowingLaparoscopic Partial Nephrectomy
Manish Vira, Kristian Novakovic*, Brian Keuer, Paul Albert*, McClellan Walther, W. Marston Linehan, Jonathan Coleman, Peter Pinto
National Institutes of Health, National Cancer Institute, Washington, DC
Introduction: Laparoscopic partial nephrectomy (LPN) has shown to be a feasible and oncologically safe technique in the surgical management of renal tumors less than 4 cm in size.
Methods: We reviewed the data from 48 patients (with both sporadic and hereditary renal cancer syndromes) who underwent LPN for renal tumors from 1999-2005. Renal function was assessed using serum creatinine, estimated creatinine clearance, 24 hour urine creatinine clearance, and differential renal scans. Postoperative renal function studies were completed at least 1 month (median 3.5 months) following surgery.
Results: A total of 28 patients underwent LPN without arterial clamping and 20 patients with arterial clamping with mean clamp time of 28.2 minutes (range 10-67). The average tumor size in each group was 2.35 cm and 2.75 cm. Comparing the geometric mean ratio of the change in renal function, there is statistically significant increase in serum creatinine (by 7.2%, p=0.002), decrease in estimated creatinine clearance (by 6.3%, p=0.003), and decrease in measured creatinine clearance (by 11.9%, p=0.009). Linear regression analysis revealed that among sex, age at surgery, number of tumors, size, arterial occlusion, operative time and estimated blood loss, only operative time showed a statistically weak association with increase in serum creatinine (and decrease in estimated creatinine clearance) following surgery.
Conclusions: Overall, we found a small statistically significant (but maybe clinically insignificant) decrease in postoperative renal function following laparoscopic partial nephrectomy. Laparoscopic partial nephrectomy with or without arterial occlusion was performed safely in our patient cohort, including those with multiple renal tumors.
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