Investig Clin Urol.  2020 Sep;61(5):464-474. 10.4111/icu.20190313.

Effectiveness and safety of partial nephrectomy no ischemia vs. warm ischemia: Systematic review and meta-analysis

• Mina-Riascos SH
• Vitagliano G
• García-Perdomo HA

• KMID: 2505409
• DOI: http://doi.org/10.4111/icu.20190313

Abstract

Purpose
This study aimed to determine the effectiveness and safety of partial nephrectomy (PN) without ischemia compared with PN with warm ischemia for reducing the deterioration in renal function in patients with cT1 renal tumors.
Materials and Methods
We conducted a systematic review that included patients over 18 years of age who underwent PN with or without warm ischemia for cT1 renal tumors. The primary outcome was impaired renal function. A search strategy was performed in MEDLINE, EMBASE, LILACS, CENTRAL, the article reference lists, and the unpublished literature to reach saturation of the information. We assessed the risk of bias with the methodological index for nonrandomized studies (MINORS) tool, and we performed a meta-analysis according to the type of variable.
Results
We found a total of 5,682 articles, of which 14 met the inclusion criteria. Seven studies evaluated renal function, identifying a difference in means (MD) of 3.50 (95% confidence interval [CI], 1.16 to 5.83), favoring no ischemia. We did not find any significant differences regarding intraoperative bleeding or operative time (MD, 55 mL; 95% CI, -33.16 to 144.08; and MD, 1.87; 95% CI, -20.47 to 24.21; respectively).
Conclusions
In this study, PN without ischemia showed a decrease in deterioration of the estimated glomerular filtration rate compared with warm ischemia.

Keyword

Cold ischemia; Meta-analysis; Nephrectomy; Systematic review; Warm ischemia