The impact of ischemia time during open nephron sparing surgery on solitary kidneys: A multi-institutional study

被引:304
作者
Houston Thompson, R.
Frank, Igor
Lohse, Christine M.
Saad, Ismail R.
Fergany, Amr
Zincke, Horst
Leibovich, Bradley C.
Blute, Michael L.
Novick, Andrew C.
机构
[1] Cleveland Clin Fdn, Glickman Urol Inst, Cleveland, OH 44195 USA
[2] Mayo Clin & Mayo Fdn, Mayo Med Sch, Dept Urol, Rochester, MN 55905 USA
[3] Mayo Clin & Mayo Fdn, Mayo Med Sch, Hlth Sci Res, Rochester, MN 55905 USA
[4] Mayo Clin, Rochester, MN USA
关键词
kidney neoplasms; nephrectomy; postoperative complications; warm ischemia; cold ischemia;
D O I
10.1016/j.juro.2006.09.036
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 [临床医学]; 100201 [内科学];
摘要
Purpose: The safe duration of ischemia during nephron sparing surgery remains controversial. We performed a multi-institutional study to evaluate the renal effects of vascular clamping in patients with solitary kidneys. Materials and Methods: Using the Cleveland Clinic and Mayo Clinic databases, we identified 537 patients with solitary kidneys who underwent open nephron sparing surgery. Renal complications were compared among patients who did not require vascular clamping (85), and those who had warm ischemia (174) and cold ischemia (278). Results: Median patient age (63, 65, 64 years) and preoperative creatinine (1.4, 1.3, 1.4 mg/dl) were similar among patients with no ischemia, warm ischemia and cold ischemia, respectively. Median tumor size was smaller in patients with no ischemia (2.5 cm), compared to patients with warm (3.5 cm) and cold (4.0 cm) ischemia (p < 0.001). Warm and cold ischemia was associated with a significantly increased risk of urine leak (p = 0.006), acute (p < 0.001) and chronic (p = 0.027) renal failure, and temporary dialysis (p = 0.028) compared to patients with no ischemia. Warm ischemia longer than 20 minutes and cold ischemia longer than 35 minutes were associated with a higher incidence of acute renal failure (p = 0.002 and p = 0.003, respectively). Additionally, warm ischemia more than 20 minutes was associated with an increased risk of chronic renal insufficiency (41% vs 19%, p = 0.008), increase in creatinine greater than 0.5 (42% vs 15%, p < 0.001) and permanent dialysis (10% vs 4%, p = 0.145). Conclusions: Vascular clamping during open nephron sparing surgery is associated with a higher incidence of renal complications. Attempts to limit warm ischemia to 20 minutes and cold ischemia to 35 minutes should be used when vascular clamping is necessary.
引用
收藏
页码:471 / 476
页数:6
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