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Page 2 of 13 Parra et al. Mini-invasive Surg 2024;8:16 https://dx.doi.org/10.20517/2574-1225.2024.01

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was 83 mL/min/1.73 m (IQR 66.2-93.6). On the first postoperative day, the median GFR was 78.4 (SD 21.8), and
at 6 months, it was 75.2 (SD 22). We found no statistically significant differences between having hypertension or
diabetes mellitus and GFR after surgery, but we found differences in the correlation of a Charlson index ≥ 3 and
deterioration of renal function, being the P values 0.01, 0.08 and 0.00 for the first postoperative day, after three
and 6 months, respectively. No statistically significant differences were found in whether having a previous chronic
kidney disease influenced the decision to perform arterial clamping or not, with a P value of 0.104. Statistically
significant differences were found in the relationship between R.E.N.A.L. score and ischemia time.

Conclusion: Renal tumors with a higher R.E.N.A.L. score involve the need to accomplish a longer arterial clamping,
but its relationship with the deterioration of renal function is unclear, since there are other risk factors, such as
patient’s comorbidities.

Keywords: Renal cell carcinoma, partial nephrectomy, renal ischemia

INTRODUCTION
Renal cell carcinoma constitutes around 3% of all cancers, with the highest incidence in Western countries.
This higher rate in Europe and North America is said to have its cause in a greater prevalence of incidental
small renal masses (SRMs) in conditions where abdominal and pelvic imaging is more commonly
[1]
conducted . A SRM is a ≤ 4 cms (T1a) solid or cystic lesion with contrast enhancement, typically
incidentally diagnosticated . Reports indicate that 80% of SRMs are malignant, most of them being low
[2]
grade and at an early phase .
[3]
For little and confined renal masses, partial nephrectomy (PN) is the usual agreeing with the most
[4-6]
universally used management guidelines . The preference for PN over radical nephrectomy (RN) is clearly
related to a decreased risk of chronic kidney disease (CKD), since association of RN with development of
postoperative CKD is well described and accepted and postoperative development of estimated glomerular
[7]
filtration rate (eGFR) < 45 is associated with increased risk of overall mortality . Therefore, PN has
emerged as the standard for most clinical T1 and T2 Renal Cell Carcinoma and may be considered an
option in selected T3a tumors with indication for nephron preservation.

However, PN still conveys the possibility of renal failure resultant of the deletion of nephrons and/or as an
effect of ischemic damage produced by arterial clamping. The significance of these aspects and the lasting
clinical consequences of renal failure remain issues of debate . Off-clamp or segmental clamping methods
[8]
in PN could remove ischemia from the procedure, but their technical execution presents challenges, and no
[9]
unquestionable functional benefits have been illustrated .
We attempt to provide a narrative review of the data concerning the association between ischemia and
functional outcomes following PN, as well as a debate of new improvements and constant investigation. In
addition, we analyzed the characteristics of patients undergoing PN in our center and their oncological and
functional outcomes in relation to ischemia time.

METHODS
We retrospectively studied 148 patients who underwent laparoscopic PN (LPN) at our center between
March 2015 and January 2021. We obtained the ethical approval for the study from our internal
Institutional Review Board (IRB) committee, with Approval No: 23-038. Besides, the consent to participate
was obtained from every patient.