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

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.