MP37-03 ROBOT-ASSISTED PARTIAL NEPHRECTOMY IS SUPERIOR IN TERMS OF POSTOPERATIVE ACUTE KIDNEY INJURY, AS COMPARED TO OPEN PARTIAL NEPHRECTOMY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy II (MP37)1 Apr 2019MP37-03 ROBOT-ASSISTED PARTIAL NEPHRECTOMY IS SUPERIOR IN TERMS OF POSTOPERATIVE ACUTE KIDNEY INJURY, AS COMPARED TO OPEN PARTIAL NEPHRECTOMY Hidekazu Tachibana* and Tsunenori Kondo Hidekazu Tachibana*Hidekazu Tachibana* More articles by this author and Tsunenori KondoTsunenori Kondo More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556033.03194.23AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Acute kidney injury (AKI) after partial nephrectomy is due to parenchymal reduction and ischemia, but the extent of each impact remains unclear. Our primary aim was to identify the predictive factors associated with postoperative AKI. The secondary aim was to compare robot-assisted partial nephrectomy (RAPN), laparoscopic partial nephrectomy (LPN), and open partial nephrectomy (OPN) in terms of postoperative AKI and evaluate the validity of RAPN. METHODS: Patients who underwent RAPN, LPN, and OPN for renal tumors at our institution between 2004 and 2016 were retrospectively analyzed. RAPN and LPN were performed under warm ischemia, and OPN was performed under cold ischemia. Prolonged renal ischemia involved >25 min warm ischemia and >50 min cold ischemia. AKI was defined as %decrease to nadir estimated glomerular filtration rate (eGFR) >25%. First, multivariate regression analysis was used to test associations of AKI with perioperative factors. Second, we compared the incidence of AKI with 2 propensity-score-matched cohorts: RAPN vs. OPN and RAPN vs. LPN. RESULTS: We included 1,244 cases (RAPN: 317, LPN: 214, OPN: 713) in this study. Prolonged ischemia, tumor size, solitary kidney, and surgical procedure were significantly associated with AKI (Table 1). After matching, 134 cases in RAPN and LPN and 249 cases in RAPN and OPN were selected. RAPN had shorter warm ischemia time than LPN, lower incidence of AKI, and lower %decrease in eGFR after 3 months. Meanwhile, RAPN had a shorter ischemia time and a lower incidence of AKI than OPN, although the %decrease in eGFR after 3 months did not differ significantly (Table 2A, B). CONCLUSIONS: The incidence of AKI was lower in RAPN than in LPN or OPN, which may be due to the shorter ischemia time. Although long-term renal outcomes did not differ between RAPN and OPN, RAPN can help prevent AKI. This information supports the validity of RAPN for patients with chronic kidney disease, including solitary kidneys. Source of Funding: none Tokyo, Japan© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e523-e523 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hidekazu Tachibana* More articles by this author Tsunenori Kondo More articles by this author Expand All Advertisement PDF downloadLoading ...