Research ArticleClinical Studies
Open Access

Association Between Early Recovery of Renal Function and Residual Renal Function After Robot-assisted Partial Nephrectomy

SHUNTA HORI, MITSURU TOMIZAWA, KENTA ONISHI, YOSUKE MORIZAWA, DAISUKE GOTOH, TOMONORI NAKAHAMA, YASUSHI NAKAI, MAKITO MIYAKE, TATSUO YONEDA, NOBUMICHI TANAKA and KIYOHIDE FUJIMOTO
In Vivo May 2025, 39 (3) 1554-1566; DOI: https://doi.org/10.21873/invivo.13955

Abstract

Background/Aim: This study aimed to explore factors related to residual renal function in patients with small renal tumors treated with robot-assisted partial nephrectomy.

Patients and Methods: This retrospective study included 188 patients with two functioning kidneys who were diagnosed with localized renal tumors and underwent robot-assisted partial nephrectomy using the clamping technique. The residual renal function 12 months after the surgery was evaluated in two ways: >90% preservation of the estimated glomerular filtration rate and no stage progression of chronic kidney disease.

Results: The median age, body mass index, and warm ischemic time were 68 years, 23.3 kg/m2, and 19 min, respectively. Ten patients were diagnosed with positive surgical margins. Multivariate analysis revealed no significant preoperative factors, including renal function. Among surgical factors, warm ischemic time was an independent factor for chronic kidney disease progression, whereas it showed no significant association with the preservation of residual renal function (p =0.042 and p=0.14, respectively). Early recovery, defined as the difference in estimated glomerular filtration rate before and three months post-surgery, independently correlated with poor residual renal function preservation and chronic kidney disease progression (p<0.0001 and p<0.0001, respectively). Furthermore, no significant difference was observed in residual renal function recovery between warm ischemic time <25 and ≥25 min (p=0.58).

Conclusion: Early recovery from residual renal function was crucial for preserving residual renal function and preventing chronic kidney disease progression after surgery. Understanding the factors influencing residual renal function preservation might lead to the optimization of treatment strategies in current clinical practice.

Keywords:

Introduction

Robot-assisted partial nephrectomy (RAPN) is considered the gold standard for treating small renal masses. Although concerns persist regarding differences in oncological and functional outcomes between radical nephrectomy (RN) and partial nephrectomy (PN), a systematic review showed that PN was inferior to RN in both oncological as well as functional outcomes, even in patients with renal tumors of sizes ≥7 cm (1). Another systematic review indicated that RAPN had a low risk of conversion to open surgery or RN, short warm ischemic time (WIT), and better preservation of residual renal function (RRF) compared with laparoscopic PN (2). Considering these previous studies, the introduction of RAPN has enabled urologists to safely perform PN with enhanced safety and ease. Further advancements in RAPN, such as challenging more complex and/or large renal tumors and/or further improving RRF preservation, have in turn improved patient outcomes and clinical practice.

To evaluate surgical quality, the trifecta (negative surgical margin, WIT <25 min, and no perioperative complications) (3) or pentafecta [all three trifecta criteria in addition to >90% preservation of the estimated glomerular filtration rate (eGFR) and no stage progression of chronic kidney disease (CKD) at 1-year follow-up] (4) achievement rates have been introduced in RAPN. Our previous report demonstrated a trifecta achievement of 71.4%, indicating that RAPN could deliver acceptable oncological outcomes with fewer complications, even in patients with more complex renal tumors (5). Regarding RRF, although clamping techniques and/or WIT have been associated with RRF following RAPN, its long-term predictors are still controversial. A previous report identified WIT, preoperative renal function, and body mass index (BMI) as independent predictive factors of RRF after RAPN (6). Our previous findings contradicted that WIT during surgery did not correlate with RRF, and only a high BMI was associated with RRF 12 months post-RAPN (5). Another report using propensity score-matched analysis including 570 patients with small and less complex renal tumors showed that RAPN resulted in better preservation of RRF than did open PN, despite a shorter WIT in the open PN group (7).

Although RAPN plays an important role in the surgery of renal tumors, including complex cases, RRF preservation remains a paramount issue. In this study, we focused on RRF after RAPN and aimed to explore factors influencing its preservation. Understanding the current state of clinical practice and the associated challenges can pave the way for optimal management strategies and improved oncological and functional outcomes in patients undergoing RAPN.

Patients and Methods

Patient selection and data collection. This study was approved by the Research Ethics Committee of the institution through a centralized institutional review board. The requirement for patient informed consent was waived due to the retrospective nature of this analysis. The study was conducted in accordance with the provisions of the Declaration of Helsinki (2013). This study included 188 consecutive patients with two functioning kidneys who underwent RAPN at our institute between December 2016 and September 2022. We retrospectively reviewed the medical charts of donors and obtained their clinical information.

Procedures for tumor resection. Tumors were resected using cold scissors after clamping the main renal artery with a bulldog. During resection, surgeons focused on maintaining a surgical margin of up to 5 mm. After tumor removal, TachoSil (CSL Behring K.K., Tokyo, Japan) were attached to the resection surface for hemostasis and an inner running suture with 3-0 V-Loc (COVIDIEN Japan, Inc., Tokyo, Japan) was carried out in case of an opened collecting system. After declamping the main renal artery, additional measures, such as soft coagulation, inner suturing, and/or TachoSil attachment were performed to control bleeding from the resection surface. In case of the opened collecting system and/or insufficient hemostasis, parenchymal sutures were added as an outer running suture with 2-0 V-Loc (COVIDIEN Japan, Inc.).

Definition of early recovery of renal function and residual renal function. The difference between preoperative eGFR and eGFR at three months after RAPN was defined as ΔeGFR with reference to a previous report by van der Weijden et al. (8). Patients were divided into early (ΔeGFR ≥−3) and late (ΔeGFR <−3) recovery group. The RRF was evaluated via the eGFR at 12 months post-surgery, which was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation (9). Good preservation of RRF was defined as a minimum 90% of total eGFR preservation, which was one of the elements in pentafecta outcome of RAPN established by Zargar et al. (4) CKD stage was classified according to the Kidney Disease: Improving Global Outcomes guidelines published in 2012: CKD Grade 1(G1) ≥90; CKD Grade 2 (G2) 60-89.9; CKD Grade 3a (G3a) 45-59.9; CKD Grade 3 b (G3b) 30-44.9; CKD Grade 4 (G4) 15-29.9; CKD Grade 5 (G5) <15 ml/min/1.73 m2 (10).

Outcomes. The primary outcome of this study was RRF at 12 months following RAPN, while the secondary outcome was to explore factors related to RRF preservation.

Statistical analysis. Continuous variables are reported as median and interquartile range (IQR), while categorical variables are expressed as numbers and percentages. The Mann-Whitney U-test or Fisher’s exact test was used to compare groups, as appropriate. Statistical analyses were performed, and figures were plotted using GraphPad Prism 9.0 (GraphPad Software, San Diego, CA, USA). The cutoff values for continuous variables were identified based on a receiver operating characteristic curve analysis. A survival curve was generated using the Kaplan–Meier method and compared using the log-rank test. A Sankey diagram was plotted using R:4.0.1 (The R Foundation, Vienna, Austria). Furthermore, multivariate logistic regression analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 19 (SPSS Inc., Chicago, IL, USA). Two-sided tests were employed in all cases, and a p-value <0.05 was considered statistically significant.

Results

Patient characteristics. Of the 188 consecutive patients with two functioning kidneys, 11, 17, and five were excluded from the analysis owing to lack of data, referral to another hospital, and RAPN using the unclamping method, respectively (Figure 1A). The clinical characteristics of the remaining 155 patients who underwent RAPN are presented in Table I. The median age and BMI at surgery were 68 years (IQR=58-74) and 23.3 kg/m2 (21.3-25.7), respectively. The cohort comprised 101 male patients (65.2%), with a median RENAL nephrometry score of seven (6-8). Among 155 patients, 37 (23.9%) and 80 (51.6%) had diabetes mellitus and hypertension, respectively. The median tumor size and eGFR were 2.4 cm (1.8-3.2) and 64.6 ml/min/1.73 m2 (52.2-77.0), respectively. Table II summarizes the surgical information and clinical outcomes of the cohort, including the RRF. The median console time and WIT were 125 min (98-170) and 19 min (14-24), respectively. Of the 155 resected tumors, 136 (87.7%) were pathological T1a, while 118 (76.1%) were clear cell types. In this cohort, 10 (6.5%) patients were diagnosed with positive surgical margins. The 5-year overall survival rate was 91.9% (Figure 1B). Eventually, four (2.6%) patients died of any cause and no cancer-related death. One (0.6%) patient developed metastatic disease (sacrum) and two patients (1.3%) had local recurrence. The median eGFR at 3, 6, and 12 months after RAPN were 61.4 (50.6-74.0), 60.8 (50.5-71.4), and 59.4 (49.5-71.9) ml/min/1.73 m2, respectively. The achievement rates of >90% preservation and CKD progression were 85 (54.8%) and 46 (29.7%), respectively. A novel induction of dialysis after surgery was observed in one patient (0.6%).

Figure 1.
Figure 1.

Flowchart of the study and prognosis after surgery. A total of 188 consecutive patients underwent robot-assisted partial nephrectomy (RAPN) for small renal masses at our institution. Patients who did not meet the inclusion criteria were excluded. Finally, 155 patients were included in the study (A). The survival rates were 100% at one year, 96.7% at three years, and 91.9% at five years after RAPN (B). The Sankey diagram shows chronological changes in the estimated glomerular filtration rate (C). N: Number; RAPN: robot-assisted partial nephrectomy.

View this table:
Table I.

Clinical information of this cohort.

View this table:
Table II.

Surgical information and clinical outcomes of this cohort.

Chronological trends and distribution of renal function. The Sankey diagram showed an early trend in the eGFR after RAPN (Figure 1C). Of 155 patients, 95 (61.3%) had an eGFR ≥60 ml/min/1.73 m2 preoperatively, whereas 12 months after RAPN, 76 (49.0%) patients had an eGFR ≥60 ml/min/1.73 m2. In contrast, 39 (25.2%) and 21 (13.5%) patients had an eGFR of 45-60 and <45 ml/min/1.73 m2 preoperatively, respectively, whereas eGFR of 51 (32.9%) and 28 (18.1%) patients were 45-60 and <45 ml/min/1.73 m2, respectively, 12 months post-RAPN. Most patients with eGFR <45 ml/min/1.73 m2 at three months after RAPN tended to maintain this level at 12 months after RAPN as well. Regarding CKD classification, the populations of G1, G2, and G3a decreased 12 months after RAPN, whereas G3a and G3b populations increased (Figure 2A). The number of patients classified as G1 or G2 preoperatively significantly decreased 12 months after RAPN (Figure 2B; p=0.039). Furthermore, the 90% RRF preservation rates were not associated with preoperative renal function; thus, patients with poor RRF preservation did not necessarily exhibit poor preoperative renal function (Figure 2C). Additionally, no significant difference in the population of patients with poor preservation between patients with ≤G2 and ≥G3 (Figure 2D; p=0.74), was observed. On the contrary, the CKD progression rate was high in patients with G1 (Figure 2E), and those with G2 were at a significantly higher risk of CKD progression than were those with ≥G3 (Figure 2F; p=0.047).

Figure 2.
Figure 2.
Figure 2.

Comparison of renal function with surgery, renal function preservation, and chronic kidney disease stage progression. After robot-assisted partial nephrectomy (RAPN), chronic kidney disease (CKD) grade (G) 1 and G2 populations decreased, whereas those of G3a and G3b increased (A), and there was significant difference in the population between patients with ≤G2 and ≥G3 before and after RAPN (B). The distribution, depicting whether >90% of preoperative renal function was preserved, shows that preservation rates may not be influenced by the preoperative CKD stage (C). No significant difference in the preservation rate was observed between patients with ≤G2 and ≥G3 preoperatively (D). Patients with relatively better stage before RAPN tended to worsen CKD stage post-RAPN (E). A significant difference in progression rates is evident between patients with ≤G2 and ≥G3 preoperatively (F).

Predictive factors for poor preservation of RRF. Table III presents the logistic multivariate analysis results of factors related to poor preservation of RRF and CKD progression after RAPN. No significant preoperative patient factors, including preoperative renal function, were identified. Among surgical factors, WIT was found to be an independent factor for CKD progression, whereas it showed no significant correlation with RRF preservation [odds ratio (OR)=2.63, 95% confidence interval (CI)=1.04-6.70, p=0.042; OR=1.91, 95%CI=0.81-4.51, p=0.14]. Early recovery, a postoperative factor, was independently associated with poor preservation of RRF and CKD progression (OR=4.16, 95%CI=2.01-8.61, p<0.0001; OR=4.67, 95%CI=2.00-10.87, p<0.0001). Patients with preoperative eGFR ≥60 tended to be at a higher risk of CKD progression compared with those with eGFR <60 (OR=0.39, 95%CI=0.15-1.01, p=0.053). In case of patients with WIT <25, early recovery emerged as an independent factor for predicting both poor preservation and CKD progression (Table IV: OR=3.36, 95%CI=1.46-7.72, p=0.004; OR=3.78, 95%CI=1.38-10.35, p=0.010, respectively).

View this table:
Table III.

Multivariate analysis of predictive factors for poor preservation of residual renal function.

View this table:
Table IV.

Multivariate analysis of predictive factors for poor preservation of residual renal function in patients with warm ischemic time <25.

Association of ΔeGFR with CKD stage and WIT. The association between the degree of RRF recovery, preoperative renal function, and WIT revealed that patients with good preoperative renal function tended to recover later in this study (Figure 3A). However, these results should be interpreted with caution because of the limited number of patients in G4 or G5. No significant difference in the degree of RRF recovery was observed between patients with ≤G2 and ≥G3 preoperatively (Figure 3B; p=0.11) and those with WIT <25 and ≥25 (Figure 3C; p=0.58).

Figure 3.
Figure 3.

Association of renal function recovery with preoperative renal function and warm ischemic time. Patients with relatively better stage before robot-assisted partial nephrectomy (RAPN) tended to exhibit delayed recovery of residual renal function (RRF) (A). However, no significant difference in renal function recovery was observed between patients with chronic kidney disease stage ≤grade (G) 2 and ≥G3 preoperatively (B). In addition, no significant difference in renal function recovery was noted between patients with warm ischemic time (WIT) <25 and ≥25 (C).

Discussion

The present study highlights the pivotal role of ΔeGFR in predicting RRF post-RAPN and distinguishing high-risk patients with <90% RRF preservation or CKD progression. Contrary to our initial hypothesis that decreased preoperative renal function or prolonged WIT may strongly associate with a low RRF preservation rate after RAPN, in this study, we found no association between preoperative or perioperative factors, including renal function, complications, such as diabetes mellitus and hypertension, or WIT, and RRF. Instead, ΔeGFR, as a postoperative factor, was the sole independent factor associated with RRF preservation. Regarding CKD stage, both ΔeGFR and WIT were identified as independent factors for CKD progression. Figure 4 shows the summary of the present study. Although the follow-up period in this study was short, and thus warranting cautious interpretation, these findings suggest potential for improvement in RRF through interventions, such as renal rehabilitation and/or medications.

Figure 4.
Figure 4.

Summary of the present study. In this study, warm ischemic time (WIT) was not associated with >90% preservation of renal function, but it does influence chronic kidney disease (CKD) progression; thus, surgeons should make every effort to minimize WIT. Early recovery of renal function is important for predicting residual renal function (RRF). Therefore, future interventions to improve RRF preservation, such as renal rehabilitation or medications, should be duly considered (D). RAPN: Robot-assisted partial nephrectomy.

The role of WIT in long-term RRF remains controversial. Previous reports on renal damage induced by warm ischemia indicated that patients with WIT >28 had a significantly greater reduction in GFR as measured by renal scintigraphy three months after PN (11). Another report demonstrated that total RRF was hardly unaffected by PN, while WIT ≥25 caused irreversible damage throughout the treated kidney at one week after PN (12). As a long-term outcome, a prospective observational study revealed that WIT contributed to irreversible kidney damage at three months after PN, with WIT being a significant RRF predictor at 48 months after PN (13). In contrast, Shikanov et al. (14) suggested that renal damage caused by warm ischemia was associated with an immediate but not a long-term decrease in renal function in patients with two functioning kidneys. Ohba et al. (15) also suggested that whether or not to undergo parenchymal suturing was more important for renal preservation than WIT. In this study, WIT <25 was an independent factor for predicting CKD progression but not poor RRF preservation at 12 months after RAPN. Although WIT is certainly not harmless to RRF, the compensatory effect of the contralateral kidney may mask the effect of ischemic injury by clamping during RAPN. A previous report also showed that patients with WIT ≥25 were at high risk of CKD progression (16). Considering compensatory effect, patients with WIT ≥25 may exhibit a low potential for renal preservation, prompting urologists to pay close attention to these patients after RAPN. Preventing and minimizing irreversible ischemic damage hold substantial promise and warrant prioritization in research.

Preoperative renal function closely correlates with the preservation capability of RRF. Notably, patients with preoperative CKD have particularly benefited from PN in preserving RRF, thereby preventing adverse cardio-vascular effects associated with CKD (17, 18). In our study, although a clear association existed between preoperative renal function and RRF preservation, patients with better preoperative CKD tended to progress to a higher CKD stage after RAPN. Indeed, the number of patients with G4 or G5 was limited; thus, results need to be carefully interpreted, as patients with relatively better preoperative renal function may have some form of tolerance, including serum cytokines and/or histological features, to the renal damage induced by vascular clamping during RAPN. Although the reasons for this remain unclear, RAPN can prove valuable in patients even with impairments in preoperative renal function.

RAPN is a better surgical procedure for small renal tumors than RN in terms of renal function preservation (19) and RAPN can also preserve renal function as well as percutaneous cryoablation for small renal tumors (20). Furthermore, preserving RRF can lead to a decreased risk of end-stage renal disease (21), cardiovascular morbidity (22), and mortality (23). Various studies on renal function preservation following RAPN predominantly focus on preoperative or surgical factors. Most prediction models for RRF post-RAPN also include patient-related (age, BMI, etc.), kidney-related (preoperative renal function, kidney volume, etc.), tumor-related (tumor size, tumor complexity, etc.), surgery-related (WIT, surgical approach, etc.), and provider-related factors (surgeon’s experience, center volume) (24), while postoperative factors such as early recovery are not considered. In our study, early recovery from RRF was strongly correlated with the RRF at 12 months after RAPN. Prior studies have emphasized the importance of postoperative renal function for predicting long-term RRF post-RAPN (25-28). Most of these studies focused on the preservation rate of renal function immediately after surgery, whereas Dawidek et al. (28) evaluated RRF approximately three months after surgery and concluded that the recovery potential of RRF was equivalent to the long-term recovery at 12 months following surgery. These findings align with the outcomes of the present study. Therefore, interventions such as renal rehabilitation or medications could potentially play a crucial role in preventing or facilitating RRF recovery by approximately three months after surgery.

The optimal timing for evaluating postoperative renal function and degree of recovery remains a subject of debate. In this study, ΔeGFR was calculated as the difference between preoperative and postoperative eGFR at three months after surgery with reference to a previous report on living kidney donor (8). Our primary focus was to improve the preservation or compensatory rate of RRF following surgery and design future therapeutic interventions. Indeed, evaluating immediately after surgery (25-27) provides valuable insights into postoperative management; there is room for perioperative interventions and enhancement in surgical quality. Furthermore, assessing renal function within a few weeks post-surgery may coincide with declining renal function (29) and introduce a degree of uncertainty in the clinical significance. However, evaluating a few months after surgery provides room for further intervention. Considering renal rehabilitation, a longer intervention duration may prove more effective in protecting against and/or prompting RRF.

Study limitations. First, the data were retrospectively obtained from a single institution, and the sample size was relatively small. Additionally, the follow-up period was comparatively short for a comprehensive evaluation of long-term RRF. Therefore, carefully interpreting the results is imperative and further research is essential for supporting our findings. Evidence-based recommendations for appropriate surgical decision-making and optimal management strategies are pivotal to improve patient outcomes undergoing RAPN.

Conclusion

The early recovery of RRF plays a pivotal role in both preserving RRF and averting CKD progression post-RAPN. Notably, the degree of RRF recovery might not be affected by preoperative renal function and WIT during RAPN. Although ΔeGFR stands out as a potential predictor of short-term RRF, long-term outcomes are of immense interest. Improving clinicians’ awareness of these concerns could lead to refined treatment strategies and improve outcomes in patients who underwent RAPN. Advancing our knowledge and understanding of the factors involved in preserving RRF might lead to advancements in optimal and precise management strategies, such as renal rehabilitation and medications, and enhance current clinical practice.

Acknowledgements

The Authors would like to thank all of the patients who participated in this study for their important contributions. The Authors also wish to thank Ms. Mariko Yoshimura (Department of Urology, Nara Medical University, Nara, Japan) for her invaluable help in obtaining and summarizing the data used in this study. Furthermore, the Authors would like to thank Editage (www.editage.com) for English language editing.

Footnotes

  • Authors’ Contributions

    S.H, T.Y, and K.F contributed to the conception and design. S.H, M.T, K.O, Y.M, D.G, T.N, Y.N, and M.M contributed to the acquisition of patients’ data, analysis of data, and interpretation of data. S.H, Y.N, M.M, N.T, and K.F performed the treatment. All Authors were involved in drafting the manuscript and revising it critically for important intellectual content and approved the version to be published. All Authors have participated sufficiently in this work to take public responsibility for appropriate portions of the content.

  • Conflicts of Interest

    The Authors declare that they have no competing interests in relation to this study.

  • Funding

    No funding was received. None of the Authors have any disclosures relevant to this manuscript.

  • Received January 9, 2025.
  • Revision received March 5, 2025.
  • Accepted March 6, 2025.

This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY-NC-ND) 4.0 international license (https://creativecommons.org/licenses/by-nc-nd/4.0).

References

  1. ↵
    1. Mir MC,
    2. Derweesh I,
    3. Porpiglia F,
    4. Zargar H,
    5. Mottrie A,
    6. Autorino R
    : Partial nephrectomy versus radical nephrectomy for clinical T1b and T2 renal tumors: a systematic review and meta-analysis of comparative studies. Eur Urol 71(4): 606-617, 2017. DOI: 10.1016/j.eururo.2016.08.060
    OpenUrlCrossRefPubMed
  2. ↵
    1. Choi JE,
    2. You JH,
    3. Kim DK,
    4. Rha KH,
    5. Lee SH
    : Comparison of perioperative outcomes between robotic and laparoscopic partial nephrectomy: a systematic review and meta-analysis. Eur Urol 67(5): 891-901, 2015. DOI: 10.1016/j.eururo.2014.12.028
    OpenUrlCrossRefPubMed
  3. ↵
    1. Buffi N,
    2. Lista G,
    3. Larcher A,
    4. Lughezzani G,
    5. Ficarra V,
    6. Cestari A,
    7. Lazzeri M,
    8. Guazzoni G
    : Margin, ischemia, and complications (MIC) score in partial nephrectomy: a new system for evaluating achievement of optimal outcomes in nephron-sparing surgery. Eur Urol 62(4): 617-618, 2012. DOI: 10.1016/j.eururo.2012.06.001
    OpenUrlCrossRefPubMed
  4. ↵
    1. Zargar H,
    2. Allaf ME,
    3. Bhayani S,
    4. Stifelman M,
    5. Rogers C,
    6. Ball MW,
    7. Larson J,
    8. Marshall S,
    9. Kumar R,
    10. Kaouk JH
    : Trifecta and optimal perioperative outcomes of robotic and laparoscopic partial nephrectomy in surgical treatment of small renal masses: a multi-institutional study. BJU Int 116(3): 407-414, 2015. DOI: 10.1111/bju.12933
    OpenUrlCrossRefPubMed
  5. ↵
    1. Hori S,
    2. Sakamoto K,
    3. Onishi K,
    4. Tomizawa M,
    5. Morizawa Y,
    6. Gotoh D,
    7. Nakai Y,
    8. Miyake M,
    9. Torimoto K,
    10. Yoneda T,
    11. Tanaka N,
    12. Fujimoto K
    : Perioperative outcomes of open and robot-assisted partial nephrectomy in patients with renal tumors of moderate to high complexity. Asian J Surg 46(6): 2310-2318, 2023. DOI: 10.1016/j.asjsur.2022.09.155
    OpenUrlCrossRefPubMed
  6. ↵
    1. Zargar H,
    2. Akca O,
    3. Autorino R,
    4. Brandao LF,
    5. Laydner H,
    6. Krishnan J,
    7. Samarasekera D,
    8. Stein RJ,
    9. Kaouk JH
    : Ipsilateral renal function preservation after robot-assisted partial nephrectomy (RAPN): an objective analysis using mercapto-acetyltriglycine (MAG3) renal scan data and volumetric assessment. BJU Int 115(5): 787-795, 2015. DOI: 10.1111/bju.12825
    OpenUrlCrossRefPubMed
  7. ↵
    1. Kowalewski KF,
    2. Müller D,
    3. Kirchner M,
    4. Brinster R,
    5. Mühlbauer J,
    6. Sidoti Abate MA,
    7. Walach MT,
    8. Nuhn P,
    9. Honeck P,
    10. Michel MS,
    11. Kriegmair MC
    : Robotic-assisted versus conventional open partial nephrectomy (Robocop): a propensity score-matched analysis of 249 patients. Urol Int 105(5-6): 490-498, 2021. DOI: 10.1159/000513189
    OpenUrlCrossRefPubMed
  8. ↵
    1. van der Weijden J,
    2. Mahesh SVK,
    3. van Londen M,
    4. Bakker SJL,
    5. Sanders JS,
    6. Navis G,
    7. Pol RA,
    8. Roodnat JI,
    9. Kho MML,
    10. Yakar D,
    11. Kwee TC,
    12. Nolte IM,
    13. Berger SP,
    14. De Borst MH
    : Early increase in single-kidney glomerular filtration rate after living kidney donation predicts long-term kidney function. Kidney Int 101(6): 1251-1259, 2022. DOI: 10.1016/j.kint.2022.01.034
    OpenUrlCrossRefPubMed
  9. ↵
    1. Levey AS,
    2. Stevens LA,
    3. Schmid CH,
    4. Zhang YL,
    5. Castro AF 3rd.,
    6. Feldman HI,
    7. Kusek JW,
    8. Eggers P,
    9. Van Lente F,
    10. Greene T,
    11. Coresh J, CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)
    : A new equation to estimate glomerular filtration rate. Ann Intern Med 150(9): 604-612, 2009. DOI: 10.7326/0003-4819-150-9-200905050-00006
    OpenUrlCrossRefPubMed
  10. ↵
    1. Levey AS,
    2. de Jong PE,
    3. Coresh J,
    4. El Nahas M,
    5. Astor BC,
    6. Matsushita K,
    7. Gansevoort RT,
    8. Kasiske BL,
    9. Eckardt KU
    : The definition, classification, and prognosis of chronic kidney disease: a KDIGO Controversies Conference report. Kidney Int 80(1): 17-28, 2011. DOI: 10.1038/ki.2011.310
    OpenUrlCrossRefPubMed
  11. ↵
    1. Choi JD,
    2. Park JW,
    3. Choi JY,
    4. Kim HS,
    5. Jeong BC,
    6. Jeon SS,
    7. Lee HM,
    8. Choi HY,
    9. Seo SI
    : Renal damage caused by warm ischaemia during laparoscopic and robot-assisted partial nephrectomy: an assessment using Tc 99m-DTPA glomerular filtration rate. Eur Urol 58(6): 900-905, 2010. DOI: 10.1016/j.eururo.2010.08.044
    OpenUrlCrossRefPubMed
  12. ↵
    1. Funahashi Y,
    2. Hattori R,
    3. Yamamoto T,
    4. Kamihira O,
    5. Kato K,
    6. Gotoh M
    : Ischemic renal damage after nephron-sparing surgery in patients with normal contralateral kidney. Eur Urol 55(1): 209-216, 2009. DOI: 10.1016/j.eururo.2008.07.048
    OpenUrlCrossRefPubMed
  13. ↵
    1. Porpiglia F,
    2. Fiori C,
    3. Bertolo R,
    4. Morra I,
    5. Russo R,
    6. Piccoli G,
    7. Angusti T,
    8. Podio V
    : Long-term functional evaluation of the treated kidney in a prospective series of patients who underwent laparoscopic partial nephrectomy for small renal tumors. Eur Urol 62(1): 130-135, 2012. DOI: 10.1016/j.eururo.2012.02.001
    OpenUrlCrossRefPubMed
  14. ↵
    1. Shikanov S,
    2. Lifshitz D,
    3. Chan AA,
    4. Okhunov Z,
    5. Ordonez MA,
    6. Wheat JC,
    7. Matin SF,
    8. Landman J,
    9. Wolf JS Jr.,
    10. Eggener SE,
    11. Shalhav AL
    : Impact of ischemia on renal function after laparoscopic partial nephrectomy: a multicenter study. J Urol 183(5): 1714-1718, 2010. DOI: 10.1016/j.juro.2010.01.007
    OpenUrlCrossRefPubMed
  15. ↵
    1. Ohba K,
    2. Matsuo T,
    3. Mitsunari K,
    4. Nakamura Y,
    5. Nakanishi H,
    6. Mochizuki Y,
    7. Miyata Y
    : Preservation of split renal function after laparoscopic and robot-assisted partial nephrectomy. Anticancer Res 42(6): 3055-3060, 2022. DOI: 10.21873/anticanres.15792
    OpenUrlAbstract/FREE Full Text
  16. ↵
    1. Thompson RH,
    2. Lane BR,
    3. Lohse CM,
    4. Leibovich BC,
    5. Fergany A,
    6. Frank I,
    7. Gill IS,
    8. Blute ML,
    9. Campbell SC
    : Renal function after partial nephrectomy: effect of warm ischemia relative to quantity and quality of preserved kidney. Urology 79(2): 356-360, 2012. DOI: 10.1016/j.urology.2011.10.031
    OpenUrlCrossRefPubMed
  17. ↵
    1. Huang WC,
    2. Levey AS,
    3. Serio AM,
    4. Snyder M,
    5. Vickers AJ,
    6. Raj GV,
    7. Scardino PT,
    8. Russo P
    : Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol 7(9): 735-740, 2006. DOI: 10.1016/S1470-2045(06)70803-8
    OpenUrlCrossRefPubMed
  18. ↵
    1. Russo P
    : Oncological and renal medical importance of kidney-sparing surgery. Nat Rev Urol 10(5): 292-299, 2013. DOI: 10.1038/nrurol.2013.34
    OpenUrlCrossRefPubMed
  19. ↵
    1. Scosyrev E,
    2. Messing EM,
    3. Sylvester R,
    4. Campbell S,
    5. Van Poppel H
    : Renal function after nephron-sparing surgery versus radical nephrectomy: results from EORTC randomized trial 30904. Eur Urol 65(2): 372-377, 2014. DOI: 10.1016/j.eururo.2013.06.044
    OpenUrlCrossRefPubMed
  20. ↵
    1. Uemura T,
    2. Kato T,
    3. Nagahara A,
    4. Kawashima A,
    5. Hatano K,
    6. Ujike T,
    7. Ono Y,
    8. Higashihara H,
    9. Fujita K,
    10. Fukuhara S,
    11. Kiuchi H,
    12. Imamura R,
    13. Tomiyama N,
    14. Nonomura N,
    15. Uemura M
    : Therapeutic and clinical outcomes of robot-assisted partial nephrectomy versus cryoablation for T1 renal cell carcinoma. In Vivo 35(3): 1573-1579, 2021. DOI: 10.21873/invivo.12413
    OpenUrlAbstract/FREE Full Text
  21. ↵
    1. Capitanio U,
    2. Larcher A,
    3. Terrone C,
    4. Antonelli A,
    5. Volpe A,
    6. Fiori C,
    7. Furlan M,
    8. Dehò F,
    9. Minervini A,
    10. Serni S,
    11. Porpiglia F,
    12. Trevisani F,
    13. Salonia A,
    14. Carini M,
    15. Simeone C,
    16. Montorsi F,
    17. Bertini R
    : End-stage renal disease after renal surgery in patients with normal preoperative kidney function: balancing surgical strategy and individual disorders at baseline. Eur Urol 70(4): 558-561, 2016. DOI: 10.1016/j.eururo.2016.03.023
    OpenUrlCrossRefPubMed
  22. ↵
    1. Capitanio U,
    2. Larcher A,
    3. Cianflone F,
    4. Trevisani F,
    5. Nini A,
    6. Mottrie A,
    7. Mari A,
    8. Campi R,
    9. Tellini R,
    10. Briganti A,
    11. Veccia A,
    12. Van Poppel H,
    13. Carini M,
    14. Simeone C,
    15. Salonia A,
    16. Minervini A,
    17. Antonelli A,
    18. Montorsi F,
    19. Bertini R
    : Hypertension and cardiovascular morbidity following surgery for kidney cancer. Eur Urol Oncol 3(2): 209-215, 2020. DOI: 10.1016/j.euo.2019.02.006
    OpenUrlCrossRefPubMed
  23. ↵
    1. Antonelli A,
    2. Minervini A,
    3. Sandri M,
    4. Bertini R,
    5. Bertolo R,
    6. Carini M,
    7. Furlan M,
    8. Larcher A,
    9. Mantica G,
    10. Mari A,
    11. Montorsi F,
    12. Palumbo C,
    13. Porpiglia F,
    14. Romagnani P,
    15. Simeone C,
    16. Terrone C,
    17. Capitanio U
    : Below safety limits, every unit of glomerular filtration rate counts: assessing the relationship between renal function and cancer-specific mortality in renal cell carcinoma. Eur Urol 74(5): 661-667, 2018. DOI: 10.1016/j.eururo.2018.07.029
    OpenUrlCrossRefPubMed
  24. ↵
    1. Pecoraro A,
    2. Campi R,
    3. Bertolo R,
    4. Mir MC,
    5. Marchioni M,
    6. Serni S,
    7. Joniau S,
    8. Van Poppel H,
    9. Albersen M,
    10. Roussel E
    : Estimating postoperative renal function after surgery for nonmetastatic renal masses: a systematic review of available prediction models. Eur Urol Oncol 6(2): 137-147, 2023. DOI: 10.1016/j.euo.2022.11.007
    OpenUrlCrossRefPubMed
  25. ↵
    1. Lane BR,
    2. Demirjian S,
    3. Derweesh IH,
    4. Takagi T,
    5. Zhang Z,
    6. Velet L,
    7. Ercole CE,
    8. Fergany AF,
    9. Campbell SC
    : Survival and functional stability in chronic kidney disease due to surgical removal of nephrons: importance of the new baseline glomerular filtration rate. Eur Urol 68(6): 996-1003, 2015. DOI: 10.1016/j.eururo.2015.04.043
    OpenUrlCrossRefPubMed
    1. Lifshitz DA,
    2. Shikanov SA,
    3. Razmaria AA,
    4. Eggener SE,
    5. Liao C,
    6. Chang A,
    7. Shalhav AL
    : Clinical and histologic predictors of renal function decline after laparoscopic partial nephrectomy. J Endourol 25(9): 1435-1441, 2011. DOI: 10.1089/end.2010.0646
    OpenUrlCrossRefPubMed
  27. ↵
    1. Zabell J,
    2. Demirjian S,
    3. Lane BR,
    4. Derweesh IH,
    5. Isharwal S,
    6. Suk-Ouichai C,
    7. Wu J,
    8. Palacios DA,
    9. Campbell SC
    : Predictors of long-term survival after renal cancer surgery. J Urol 199(2): 384-392, 2018. DOI: 10.1016/j.juro.2017.08.096
    OpenUrlCrossRefPubMed
  28. ↵
    1. Dawidek MT,
    2. Chan E,
    3. Boyle SL,
    4. Sener A,
    5. Luke PP
    : Assessing time of full renal recovery following minimally invasive partial nephrectomy. Urology 112: 98-102, 2018. DOI: 10.1016/j.urology.2017.10.004
    OpenUrlCrossRefPubMed
  29. ↵
    1. Mason R,
    2. Kapoor A,
    3. Liu Z,
    4. Saarela O,
    5. Tanguay S,
    6. Jewett M,
    7. Finelli A,
    8. Lacombe L,
    9. Kawakami J,
    10. Moore R,
    11. Morash C,
    12. Black P,
    13. Rendon RA
    : The natural history of renal function after surgical management of renal cell carcinoma: results from the Canadian Kidney Cancer Information System. Urol Oncol 34(11): 486.e1-486.e7, 2016. DOI: 10.1016/j.urolonc.2016.05.025
    OpenUrlCrossRefPubMed
Back to top

In this issue

Print
Download PDF
Article Alerts
Email Article
Citation Tools
Reprints and Permissions
Association Between Early Recovery of Renal Function and Residual Renal Function After Robot-assisted Partial Nephrectomy
SHUNTA HORI, MITSURU TOMIZAWA, KENTA ONISHI, YOSUKE MORIZAWA, DAISUKE GOTOH, TOMONORI NAKAHAMA, YASUSHI NAKAI, MAKITO MIYAKE, TATSUO YONEDA, NOBUMICHI TANAKA, KIYOHIDE FUJIMOTO
In Vivo May 2025, 39 (3) 1554-1566; DOI: 10.21873/invivo.13955
Twitter logo Facebook logo Mendeley logo

Jump to section

Keywords