Renal Ischemia and Function After Partial Nephrectomy: A Collaborative Review of the Literature

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Volpe A., Blute M.L., Ficarra V., Gill I.S., Kutikov A., Porpiglia F., Rogers C., Touijer K.A., Van Poppel H., Thompson R.H.

European Urology 2015

Context: Partial nephrectomy (PN) is the current gold standard treatment for small localized renal tumors.; however, the impact of duration and type of intraoperative ischemia on renal function (RF) after PN is a subject of significant debate. Objective: To review the current evidence on the relationship of intraoperative ischemia and RF after PN. Evidence acquisition: A review of English-language publications on renal ischemia and RF after PN was performed from 2005 to 2014 using the Medline, Embase, and Web of Science databases. Ninety-one articles were selected with the consensus of all authors and analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Evidence synthesis: The vast majority of reviewed studies were retrospective, nonrandomized observations. Based on the current literature, RF recovery after PN is strongly associated with preoperative RF and the amount of healthy kidney parenchyma preserved. Warm ischemia time (WIT) is modifiable and prolonged warm ischemia is significantly associated with adverse postoperative RF. Available data suggest a benefit of keeping WIT <25. min, although the level of evidence…(vermás)

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