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Impact of ischaemia time on renal function after partial nephrectomy: a systematic review
Author(s) -
Rod Xavier,
Peyronnet Benoit,
Seisen Thomas,
Pradere Benjamin,
Gomez Florie D.,
Verhoest Grégory,
Vaessen Christophe,
De La Taille Alexandre,
Bensalah Karim,
Roupret Morgan
Publication year - 2016
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.13580
Subject(s) - nephrectomy , medicine , ischemia , renal function , kidney , renal ischemia , urology , surgery , reperfusion injury
Objective To assess the impact of ischaemia on renal function after partial nephrectomy ( PN ). Materials and methods A literature review was performed according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses ( PRISMA ) criteria. In January 2015, the Medline and Embase databases were systematically searched using the protocol (‘warm ischemia’[mesh] OR ‘warm ischemia’[ti]) AND (‘nephrectomy’[mesh] OR ‘partial nephrectomy’[ti]). An updated search was performed in December 2015. Only studies based on a solitary kidney model or on a two‐kidney model but with assessment of split renal function were included in this review. Results Of the 1119 studies identified, 969 abstracts were screened after duplicates were removed: 29 articles were finally included in this review, including nine studies that focused on patients with a solitary kidney. None of the nine studies adjusting for the amount of preserved parenchyma found a negative impact of warm ischaemia time on postoperative renal function, unless this was extended beyond a 25‐min threshold. The quality and the quantity of preserved parenchyma appeared to be the main contributors to postoperative renal function. Conclusion Currently, no evidence supports that limited ischaemia time (i.e. ≤25 min) has a higher risk of reducing renal function after PN compared to a ‘zero ischaemia’ technique. Several recent studies have suggested that prolonged warm ischaemia (>25–30 min) could cause an irreversible ischaemic insult to the surgically treated kidney.