Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2024 Oct 18;42(1):582.
doi: 10.1007/s00345-024-05299-1.

Impact of tumor dissecting technique on trifecta achievement in patients requiring extended warm ischemia during robot-assisted partial nephrectomy

Yudai Ishiyama  1   2 , Tsunenori Kondo  3 , Kazuhiko Yoshida  4 , Junpei Iizuka  4 , Toshio Takagi  4
Affiliations
Multicenter Study

Impact of tumor dissecting technique on trifecta achievement in patients requiring extended warm ischemia during robot-assisted partial nephrectomy

Yudai Ishiyama et al. World J Urol. .

Abstract

Purpose: To clarify specific factors associated with surgical outcomes in robot-assisted partial nephrectomy (RAPN) that require extended warm ischemia time (WIT), which may have a negative impact, but cannot always be avoided.

Methods: We included 1,182 patients who had RAPN performed between January 2016 and December 2022 from a prospectively generated multi-institutional RAPN database, divided into normal WIT (nWIT) (≤ 20 min; 843 patients) and extended WIT (eWIT) (> 20 min; 339 patients) groups. Primary outcome measures were WIT and the Surface-Intermediate-Base (SIB) margin score, which contribute to postoperative trifecta achievement. Results were compared between the two groups using logistic regression.

Results: Patients in the eWIT group had larger tumors, higher RENAL nephrometry scores, and lower SIB scores than those of the nWIT group. The trifecta achievement rate was significantly different between the two groups (nWIT: 70.1 vs. 49.0%, p < 0.001). In the nWIT group, WIT (coefficient: -0.105 [standard error 0.020], p < 0.001) and SIB score (coefficient: -0.107 [0.053], p = 0.045) were significant predictors of trifecta achievement. In the eWIT group, the SIB score (coefficient - 0.216 [0.082], p = 0.008) was significantly associated with trifecta attainment, whereas WIT only showed a trend toward significance. Limitations included a lack of long-term survival, renal function, and chronic complications data.

Conclusions: For patients with eWIT during RAPN, the tumor dissection technique may be more important than WIT in predicting postoperative outcomes. Further prospective studies are required to confirm our results.

Keywords: Enucleation; Ischemia; Kidney cancer; Nephron-sparing surgery; Robotic surgery.

PubMed Disclaimer

References

    1. EAU Guidelines (2024) Edn. presented at the EAU Annual Congress Paris ed
    1. Jarret TW, Semerjian A (2018) Laparoscopic and robotic-assisted laparoscopic partial nephrectomy. In: Smith Jr JA, Howards SS, Preminger GM, Dmochowski RR (eds) Hinman’s atlas of urologic surgery, 4 edn. Elsevier, Philadelphia, PA
    1. Parekh DJ, Weinberg JM, Ercole B, Torkko KC, Hilton W, Bennett M et al (2013) Tolerance of the human kidney to isolated controlled ischemia. J Am Soc Nephrol 24:506–517 - DOI - PubMed - PMC
    1. Kazama A, Attawettayanon W, Munoz-Lopez C, Rathi N, Lewis K, Maina E et al (2024) Parenchymal volume preservation during partial nephrectomy: improved methodology to assess impact and predictive factors. BJU Int 134(2):219–228
    1. Munoz-Lopez C, Lewis K, Attawettayanon W, Yasuda Y, Emrich Accioly JP, Rathi N et al (2023) Functional recovery after partial nephrectomy: next generation analysis. BJU Int 132:202–209 - DOI - PubMed

Publication types

LinkOut - more resources