TY - JOUR
T1 - Can selective arterial clamping with fluorescence imaging preserve kidney function during robotic partial nephrectomy?
AU - McClintock, Tyler R.
AU - Bjurlin, Marc A.
AU - Wysock, James S.
AU - Borofsky, Michael S.
AU - Marien, Tracy P.
AU - Okoro, Chinonyerem
AU - Stifelman, Michael D.
N1 - Funding Information:
Funding Support: Tyler R. McClintock, Marc A. Bjurlin, and James S. Wysock are supported in part by grant UL1 TR000038 from the National Center for the Advancement of Translational Science (NCATS), National Institutes of Health .
PY - 2014/8
Y1 - 2014/8
N2 - Objective To compare renal functional outcomes in robotic partial nephrectomy (RPN) with selective arterial clamping guided by near-infrared fluorescence (NIRF) imaging to a matched cohort of patients who underwent RPN without selective arterial clamping and NIRF imaging. Methods From April 2011 to December 2012, NIRF imaging-enhanced RPN with selective clamping was used in 42 cases. Functional outcomes of successful cases were compared with a cohort of patients, matched by tumor size, preoperative estimated glomerular filtration rate (eGFR), functional kidney status, age, sex, body mass index, and American Society of Anesthesiologists score, who underwent RPN without selective clamping and NIRF imaging. Results In matched-pair analysis, selective clamping with NIRF was associated with superior kidney function at discharge, as demonstrated by postoperative eGFR (78.2 vs 68.5 mL/min/1.73 m2; P =.04), absolute reduction of eGFR (-2.5 vs -14.0 mL/min/1.73 m2; P <.01), and percent change in eGFR (-1.9% vs -16.8%; P <.01). Similar trends were noted at 3 month follow-up, but these differences became nonsignificant (P[eGFR] =.07; P[absolute reduction of eGFR] =.10; and P[percent change in eGFR] =.07). In the selective clamping group, a total of 4 perioperative complications occurred in 3 patients, all of which were Clavien grade I-III. Conclusion Use of NIRF imaging was associated with improved short-term renal functional outcomes when compared with RPN without selective arterial clamping and NIRF imaging. With this effect attenuated at later follow-up, randomized prospective studies and long-term assessment of kidney-specific functional outcomes are needed to further assess the benefits of this technology.
AB - Objective To compare renal functional outcomes in robotic partial nephrectomy (RPN) with selective arterial clamping guided by near-infrared fluorescence (NIRF) imaging to a matched cohort of patients who underwent RPN without selective arterial clamping and NIRF imaging. Methods From April 2011 to December 2012, NIRF imaging-enhanced RPN with selective clamping was used in 42 cases. Functional outcomes of successful cases were compared with a cohort of patients, matched by tumor size, preoperative estimated glomerular filtration rate (eGFR), functional kidney status, age, sex, body mass index, and American Society of Anesthesiologists score, who underwent RPN without selective clamping and NIRF imaging. Results In matched-pair analysis, selective clamping with NIRF was associated with superior kidney function at discharge, as demonstrated by postoperative eGFR (78.2 vs 68.5 mL/min/1.73 m2; P =.04), absolute reduction of eGFR (-2.5 vs -14.0 mL/min/1.73 m2; P <.01), and percent change in eGFR (-1.9% vs -16.8%; P <.01). Similar trends were noted at 3 month follow-up, but these differences became nonsignificant (P[eGFR] =.07; P[absolute reduction of eGFR] =.10; and P[percent change in eGFR] =.07). In the selective clamping group, a total of 4 perioperative complications occurred in 3 patients, all of which were Clavien grade I-III. Conclusion Use of NIRF imaging was associated with improved short-term renal functional outcomes when compared with RPN without selective arterial clamping and NIRF imaging. With this effect attenuated at later follow-up, randomized prospective studies and long-term assessment of kidney-specific functional outcomes are needed to further assess the benefits of this technology.
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U2 - 10.1016/j.urology.2014.02.044
DO - 10.1016/j.urology.2014.02.044
M3 - Article
C2 - 24909960
AN - SCOPUS:84904986936
SN - 0090-4295
VL - 84
SP - 327
EP - 334
JO - Urology
JF - Urology
IS - 2
ER -