• Scott E Eggener, Melanie A Clark, Sergey Shikanov, Benjamin Smith, Matthew Kaag, Paul Russo, Jeffrey C Wheat, J Stuart Wolf, Surena F Matin, William C Huang, Miriam Harel, Joseph Cambio, Arieh L Shalhav, and Jay D Raman.
• Section of Urology, University of Chicago, 5841 South Maryland Avenue, Mail Code 6038, Chicago, IL, 60614, USA, seggener@surgery.bsd.uchicago.edu.
• World J Urol. 2015 Mar 1; 33 (3): 351-7.

IntroductionWe evaluated renal function following partial nephrectomy with cold ischemia (CI) versus warm ischemia (WI).MethodsData were collected from 1,396 patients at six institutions who underwent partial nephrectomy for a renal mass with normal contralateral kidney to evaluate percent change in glomerular filtration rate (GFR) at 3-18 months. A multivariate linear regression model tested the association of percent change GFR with clinical, operative, and pathologic factors.ResultsA total of 874 patients (63 %) underwent PN with CI and 522 (37 %) with WI. All patients undergoing laparoscopic and robotic-assisted partial nephrectomy (n = 443) had WI, whereas 92 % of open partial nephrectomy patients (n = 953) had CI. The CI group had a lower mean baseline GFR (72 vs. 80 ml/min/1.73 m(2)), longer median ischemia time (33 vs. 29 min), and larger mean tumor size (3.2 vs. 2.9 cm) with more advanced pathologic stage (T1b-T3: 25 vs. 16 %) (all p values <0.001). Patients with CI and WI demonstrated 12.3 and 10.1 % reductions in renal function from baseline, respectively (p = 0.067). Increasing age, female gender, and increasing tumor size were associated with reduction in renal function (all p values <0.001). Neither renal hypothermia nor operative technique independently predicted reduced renal function. Sensitivity analyses limited to ischemia time >30 min, baseline estimated glomerular filtration rate <60 ml/min/1.73 m(2), or tumors >4 cm did not significantly alter the findings.ConclusionsIncreasing age, female gender, and larger tumor size independently predict a decrease in renal function following partial nephrectomy with a normal contralateral kidney. Within the limitations of a non-randomized comparison, including lack of parenchymal preservation percentage, neither surgical approach (open or laparoscopic) nor presence of hypothermia appears to be associated with long-term renal function.

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