Abstract:

Objective: Partial nephrectomy (PN) suggests a better renal reserve and comparable oncologic results than radical nephrectomy. Zero-ischemia PN is a technique to avoid the deleterious effects of ischemia on renal parenchyma cells. We aimed to determine the factors affecting the postoperative renal function of patients with clinical T1 tumor who either underwent zero-ischemia or ischemic PN through the open or robotic approach. Materials and Methods: The medical records of all cases with preoperative normal serum creatinine levels who underwent either on-clamp or off-clamp PN through an open or robot-assisted laparoscopic approach for T1 tumors between January 2008 and December 2018 at our center were analyzed retrospectively. Results: In total, 90 patients (i.e., 15 robotic off-clamp, 15 open off-clamp, 30 robotic on-clamp, and 30 open on-clamp PN) were included in the study. Although the decrease in the absolute estimated glomerular filtration rate (eGFR) was significantly higher in the robotic PN procedure, the percentage of decrease in the eGFR was similar between the open and robotic surgeries. According to Spearman’s correlation analysis, preoperative eGFR was the only parameter that was significantly associated with a decrease in the eGFR (r=0.546, p<0.001). Conclusion: Our findings regarding the results of renal function tests are inadequate to state that either the robotic or open zero-ischemia PN is superior to their ischemic counterpart. Besides the operative time, warm ischemia time, estimated blood loss, and excised healthy renal parenchyma cells must be considered while predicting the long-term renal function after PN.

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