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Predictors of postoperative renal functional damage after nephron-sparing surgery



Although nephron-sparing surgery has been reported not to affect total renal function, it is a non-negligible fact that functional damage of the operated kidney usually results, for various reasons. This study aimed to explore the effects of preoperative baseline characteristics, tumor characteristics, and function protection methods on postoperative renal damage.


This study was a retrospective review of 51 patients who underwent open nephron-sparing surgery. The mean age of the patients (39 men, 12 women) was 54.2 ± 13.9 years, range 32 to 71 years. The glomerular filtration rate (GFR) was measured preoperatively and 6th months after the operation. Univariate analysis was used to screen indicators with significant differences in different levels of renal function damage. All variables found to be significant on univariate analysis were entered into a multiple logistic regression model to predict risk factors for renal function damage.


Univariate analysis showed that there was a significant difference in age, GFR of operated kidney, tumor diameter, tumor depth, and ischemic protection type between patients with little damage and those with heavy damage (P < 0.05). Forward stepwise logistic regression analysis suggested that age (odds ratio, 3.08; 95% confidence interval 1.78 to 7.04; P = 0.037), preoperative GFR of operated kidney (odds ratio, 0.51; 95% confidence interval 0.11 to 0.73; P = 0.033), and tumor diameter (odds ratio, 5.49; 95% confidence interval 2.14 to 7.88; P = 0.012) and depth (odds ratio, 5.82; 95% confidence interval 2.66 to 8.06; P = 0.010) were independent risk factors for postoperative renal function damage.


Patients with older age, poor renal function, and large tumor diameter and depth might be at higher risk of renal function damage after nephron-sparing surgery.


Renal cell carcinoma, which accounts for 2% of solid tumors, is the most common urologic malignant tumor. It is estimated that renal cell carcinoma affects more than 40,000 patients annually in the United States and is responsible for approximately 13,000 deaths [1]. Radical nephrectomy has long been considered the most effective option for surgeons in the management of renal cell carcinoma. However, renal functional loss after radical nephrectomy contributes to the development of chronic kidney disease in the majority of patients, which is a significant risk factor for cardiovascular events and death [2].

Recently, nephron-sparing surgery has been the subject of much attention. Several clinical studies have already indicated that nephron-sparing surgery ensures favorable oncological results for tumors smaller than 4 cm compared with radical nephrectomy, in addition to preserving renal function [37]. Because of these beneficial outcomes, there has been an increase in the use of nephron-sparing surgery. At major urological institutions, nephron-sparing surgery is even largely used for tumors up to 7 cm in diameter, to extend elective indications [812]. However, it has been reported that nephron-sparing surgery impairs the function of the operated kidney because of temporary renal blood flow blockage for reduction of bleeding and loss of normal renal parenchyma around the tumor during resection and suture [13]. Therefore, assessing predictors of functional tissue damage of the involved kidney during nephron-sparing surgery to prevent it is still crucial for patients’ survival [14]. The aim of this study was to investigate preoperative indicators that might predict renal function damage in patients undergoing nephron-sparing surgery.


Patient selection

A total of 51 patients (approved by Xinhua Hospital, School of Medicine, Shanghai JiaoTong University ethics committee) who underwent open nephron-sparing surgery for a kidney tumor, as diagnosed by ultrasonography, computed tomography, or magnetic resonance imaging, were enrolled in this study between Jan 2009 and Dec 2011. The mean age of the patients (39 men, 12 women) was 54.2 ± 13.9 years, range 32 to 71 years. Patients with single kidneys were excluded from the study. Preoperative renal function was normal in all the patients. The patients’ blood levels of serum creatinine and urea nitrogen were 89 ± 20.1 μmol/l (range 78.5 to 109 μmol/l) and 5.7 ± 3.3 mmol/l (range 4.9 to 9.4 mmol/l), respectively. Preoperative backache was found in three cases; there was no gross hematuria or abdominal mass. All the tumors involved were unilateral (28 tumors on the left and 23 on the right kidney). According to the preoperative findings evaluated by computed tomography or magnetic resonance imaging, tumors were divided into large (diameter > 4 cm, 15 cases), medium (1 cm < diameter ≤ 4 cm, 28 cases) and small (diameter ≤ 1 cm, 8 cases) by their size. The tumors were also divided into exophytic (> 50% of the tumor circumference outside of renal parenchyma, 12 cases), central (≈ 50% of the tumor circumference outside of renal parenchyma, 26 cases) and intraparenchymal (< 50% of the tumor circumference outside of renal parenchyma, 13 cases) according to the depth of the tumor.

Surgical technique

The patients were placed in a lateral decubitus position on the unaffected side and given general anesthesia. Using an extraperitoneal flank incision through the 12th rib, the renal pedicle was dissected free between the perirenal fascia and the major psoas muscle to allow for clamping by different vessel blockage types. Selective clamping of the artery, or blocking artery and vein, followed, depending on the distribution of the renal pedicle and the morphology and location of the renal mass [15]. Routinely, the renal artery was dissected free and clamped using a Rumel tourniquet (continuous artery blocking in 32 patients). Where patients had obvious tumor adhesions to the renal pedicle or larger tumor size, the renal pedicle, including the renal artery and renal vein, were clamped with a Rumel tourniquet (19 patients) to avoid vascular injury when isolating the renal artery. Owing to the difference in the personal habits of operators, different ischemic protection types were also used for operative warm ischemia of the kidney, including local cooling (30 patients), where sterile ice slush was placed around the kidney following vascular occlusion, and mannitol application (21 patients), where 250 ml 20% mannitol solution was given intravenously and rapidly 5 min before vessel occlusion. The perirenal fascia was opened immediately after the occlusion of blood vessels. The tumor was located after dissociation of the adipose capsule and should have been completely resected, leaving a 5 to 10 mm margin of normal renal parenchyma around the tumor. If there was damage to the collection system, it was oversewn with 3–0 absorbable sutures. The wound was closed in layers with 2–0 absorbable sutures in a figure-of-eight fashion. The vascular occlusion time should be less than 30 min before blood flow recovery. Drainage of retroperitoneal space was performed for 24 to 48 h and the incision was closed routinely. Patients were placed in a horizontal position postoperatively for 72 h.

Assessment of renal function

Glomerular filtration rate (GFR) was measured using 99mTc-diethylenetriamine pentaacetic acid dynamic renal scintigraphy preoperatively and at the postoperative 6th month. The level of renal function damage was divided into ‘no damage’ (ΔGFR ≤ 10 ml/min 1.73 m2), ‘slight’ (10 ml/min 1.73 m2 < ΔGFR ≤ 20 ml/min 1.73 m2), ‘moderate’ (20 ml/min 1.73 m2 < ΔGFR ≤ 30 ml/min 1.73 m2), and ‘serious’ (ΔGFR > 30 ml/min 1.73 m2), according to the difference between preoperative and postoperative GFR (ΔGFR) of tumor-involved kidney. The levels of no and slight renal function damage were further combined into ‘little’, and the levels of moderate and serious renal function damage were combined into ‘heavy’.

Statistical analysis

One-way analysis of variance (ANOVA, for continuous variables) or chi-square test (for categorical variables) were used to filter indicators with significant differences in each level of renal function according to preoperative baseline characteristics (age and sex), tumor characteristics (location, maximum diameter, depth, and pathology) and function protection types (vessel blockage type, warm ischemic time, and ischemic protection type). All variables significant on univariate analysis were entered into a multiple logistic regression model to predict the risk factors for renal function damage (‘little’ or ‘heavy’). Statistical analyses were performed using SPSS 19.0 software. P < 0.05 was considered statistically significant.


Preoperative baseline characteristics are detailed in Table 1. All the patients successfully completed the surgery, and showed no serious complications. The protection types of renal function in surgery are shown in Table 2. Compared with preoperative GFR levels of the tumor-involved kidney, we found no, slight, moderate, and serious damage of renal function in 17, 19, 9, and 6 patients at the postoperative 6th month, respectively (Table 3). Univariate analysis indicated that there was a significant difference in age, preoperative GFR of tumor-involved kidney, tumor diameter, tumor depth, or ischemic protection type between different renal function damage groups (P < 0.05, Table 4). Forward stepwise logistic regression analysis suggested that age, preoperative GFR of tumor-involved kidney, tumor diameter and depth were independent predictors of postoperative renal function damage (P < 0.05, Table 5).

Table 1 Preoperative baseline characteristics of patients and tumors
Table 2 Protection types of renal function in surgery
Table 3 Function damage level according to ΔGFR in 51 patients
Table 4 Univariate analysis of baseline characteristics, tumor characteristics, and function protection types in each level of renal function
Table 5 Forward stepwise logistic regression analysis of the factors on renal function damage


The GFR is considered the best parameter for assessing renal function because it is directly proportional to the number of functioning nephrons [16]. In this study, we also assessed kidney function changes preoperatively and postoperatively by measuring GFR with 99mTc-diethylenetriamine pentaacetic acid renal scintigraphy [17]. In the normal population, an irreversible decline of renal function occurs with aging, showing reduced GFR levels [18]. These changes are minor, but tend to be more obvious when the kidney suffers a trauma. Tolerance to surgery is poor if the kidney has preoperative dysfunction, and postoperative damage of kidney is often serious [19]. These were also confirmed in our study; preoperative GFR of tumor-involved kidney and age of patients were independent predictors of postoperative renal function damage.

Given the validity of GFR for assessing renal function, we divided patients into those with little and heavy damage, according to GFR changes, which we used to explore risk factors for renal function damage by comparing preoperative baseline characteristics, tumor characteristics, and function protection methods between two groups. The results indicated that tumor diameter, tumor depth, or ischemic protection methods were independent predictors of postoperative renal function damage.

Tumor size is the key factor in determining surgical procedures. Generally, nephron-sparing surgery is considered the optimum treatment for tumors smaller than 4 cm in diameter [20], and nephron-sparing surgery can be offered for tumors 4 to 7 cm in diameter, but the operation is very difficult [21]. When the tumor is larger than 7 cm in diameter, radical nephrectomy should be chosen because satellite nodules could exist in the periphery of the tumor, and lead to a high postoperative local recurrence rate [22]. In this study, 15 patients had tumors larger than 4 cm in diameter, and the maximum diameter was 4.8 cm. Our results showed that the risk of renal function damage after the operation increased as the tumor diameter increased. This may be because resection of a larger tumor volume requires a longer vascular occlusion time and causes a reduced residual normal renal parenchyma.

Traditionally, excision of the tumor with a 1 cm margin of normal-appearing parenchyma is a standard technique during nephron-sparing surgery, to avoid local recurrence [23]. However, margins of 10 mm may not be desirable, as they may result in the resection of tumors close to the renal hilum and result in increasing injury to the urinary collecting system and hilar vessels [24]. Thus, a peritumoral margin smaller than 10 mm is advocated (0.5 to 1.0 cm in our study) [25]. This kind of margin is easily achievable for exophytic tumors but not intraparenchymal or juxtahilar tumors, in which adjacent vascular structures or collecting systems are located [26]. In practice, there may be some deviations in the peritumoral margin (possible larger than 1 cm) after advancing the renal parenchyma at the marked margin for patients with intraparenchymal tumors, leading to renal damage. Our results also demonstrated this conclusion that patients with a deeper tumor location had a high risk of postoperative renal function damage, although local recurrence was not found in all follow-up patients.

Recent clinical studies demonstrated that warm ischemia should be within 20 to 25 min. When the warm ischemic time is ≥ 25 minutes, irreversible diffuse damage may be seen in surgically preserved nephrons [13, 27, 28]. Moreover, some scholars suggest zero ischemia partial nephrectomy only with preoperative superselective arterial embolization [2933]. However, our results indicated there was no significant difference in ischemic time between different renal function damage groups. This may be associated with abundant collateral circulation from the adrenal and capsular branches, which leads to enhanced tolerance to ischemia [34].

Renal dysfunction is also related to the method of occlusion. Local cooling is the best way to protect renal function if the expected warm ischemic time exceeds 30 minutes [35]. Renal hypothermia in the range of 5 to 15°C is considered optimal for renal protection, based on the classic Ward experiment [36]. Nevertheless, it is difficult to fall to this standard as the kidney is exposed in the surgical field. For clinical practicability, a temperature of 20 to 25°C appears to provide complete renal protection for up to 3 h of arterial occlusion [37, 38]. Univariate analysis of our results showed that local cooling benefited the renal function; however, multivariate analysis found no significant difference. This may be due to the short vascular occlusion time in our study, with a maximum time of 38 min.


It is necessary to assess the preoperative risk and degree of renal function damage in order to protect residual renal function after nephron-sparing surgery. For patients with preoperative high-risk factors such as older age, poor preoperative renal function, large tumor size, or deep tumor location, such precautions as vascular occlusion and ischemia protection should be taken. Monitoring of patients with high-risk factors should be performed, to minimize renal function damage after nephron-sparing surgery.



Analysis of variance


Glomerular filtration rate.


  1. 1.

    Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ: Cancer statistics, 2007. CA Cancer J Clin. 2007, 57: 43-66. 10.3322/canjclin.57.1.43.

    Article  PubMed  Google Scholar 

  2. 2.

    Lane BR, Abouassaly R, Gao T, Weight CJ, Hernandez AV, Larson BT, Kaouk JH, Gill IS, Campbell SC: Active treatment of localized renal tumors may not impact overall survival in patients aged 75 years or older. Cancer. 2010, 116: 3119-3126. 10.1002/cncr.25184.

    Article  PubMed  Google Scholar 

  3. 3.

    Uzzo RG, Novick AC: Nephron sparing surgery for renal tumors: indications, techniques and outcomes. J Urol. 2001, 166: 6-18. 10.1016/S0022-5347(05)66066-1.

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Pahernik S, Roos F, Hampel C, Gillitzer R, Melchior SW, Thuroff JW: Nephron sparing surgery for renal cell carcinoma with normal contralateral kidney: 25 years of experience. J Urol. 2006, 175: 2027-2031. 10.1016/S0022-5347(06)00271-0.

    Article  PubMed  Google Scholar 

  5. 5.

    Lau WK, Blute ML, Weaver AL, Torres VE, Zincke H: Matched comparison of radical nephrectomy vs nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin Proc. 2000, 75: 1236-1242. 10.4065/75.12.1236.

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Lee CT, Katz J, Shi W, Thaler HT, Reuter VE, Russo P: Surgical management of renal tumors 4 cm. or less in a contemporary cohort. J Urol. 2000, 163: 730-736. 10.1016/S0022-5347(05)67793-2.

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Lerner SE, Hawkins CA, Blute ML, Grabner A, Wollan PC, Eickholt JT, Zincke H: Disease outcome in patients with low stage renal cell carcinoma treated with nephron sparing or radical surgery. J Urol. 1996, 155: 1868-1873. 10.1016/S0022-5347(01)66032-4.

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Becker F, Siemer S, Rotering J, Suttmann H, Stockle M: Nephron-sparing surgery. Urologe A. 2008, 47: 215-222. 10.1007/s00120-008-1651-3. quiz 223

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Nemr E, Azar G, Fakih F, Chalouhy E, Moukarzel M, Sarkis P, Khoury R, Ayoub N, Merhej S: Partial nephrectomy for renal cancers larger than 4 cm. Prog Urol. 2007, 17: 810-814. 10.1016/S1166-7087(07)92297-6.

    Article  PubMed  Google Scholar 

  10. 10.

    Mitchell RE, Gilbert SM, Murphy AM, Olsson CA, Benson MC, McKiernan JM: Partial nephrectomy and radical nephrectomy offer similar cancer outcomes in renal cortical tumors 4 cm or larger. Urology. 2006, 67: 260-264. 10.1016/j.urology.2005.08.057.

    Article  PubMed  Google Scholar 

  11. 11.

    Dash A, Vickers AJ, Schachter LR, Bach AM, Snyder ME, Russo P: Comparison of outcomes in elective partial vs radical nephrectomy for clear cell renal cell carcinoma of 4–7 cm. BJU Int. 2006, 97: 939-945. 10.1111/j.1464-410X.2006.06060.x.

    Article  PubMed  Google Scholar 

  12. 12.

    Becker F, Siemer S, Hack M, Humke U, Ziegler M, Stockle M: Excellent long-term cancer control with elective nephron-sparing surgery for selected renal cell carcinomas measuring more than 4 cm. Eur Urol. 2006, 49: 1058-1063. 10.1016/j.eururo.2006.03.003. discussion 1063–1054

    Article  PubMed  Google Scholar 

  13. 13.

    Funahashi Y, Hattori R, Yamamoto T, Kamihira O, Kato K, Gotoh M: Ischemic renal damage after nephron-sparing surgery in patients with normal contralateral kidney. Eur Urol. 2009, 55: 209-216. 10.1016/j.eururo.2008.07.048.

    Article  PubMed  Google Scholar 

  14. 14.

    Nativ O, Levi A, Farfara R, Halachmi S, Moskovitz B: Degree and predictors of functional loss of the operated kidney following nephron-sparing surgery: assessment by quantitative SPECT of 99m Tc-dimercaptosuccinic acid scintigraphy. Advances Urol. 2011, 10.1155/2011/961525.

    Google Scholar 

  15. 15.

    Cáceres F, Núñez-Mora C, Cabrera P, García-Mediero J, García-Tello A, Angulo J: Laparoscopic partial nephrectomy. Actas Urol Esp. 2011, 35: 487-493. 10.1016/j.acuroe.2011.03.013.

    Article  PubMed  Google Scholar 

  16. 16.

    Zimmerman RE, Mitchell K, Davis RT: Calculation of glomerular filtration rate. Pediatric Nuclear Medicine/PET. Edited by: Treves ST. 2007, New York: Springer, 307-311. 3

    Google Scholar 

  17. 17.

    Choi JD, Park JW, Choi JY, Kim HS, Jeong BC, Jeon SS, Lee HM, Choi HY, Seo SI: Renal damage caused by warm ischaemia during laparoscopic and robot-assisted partial nephrectomy: an assessment using Tc 99m-DTPA glomerular filtration rate. Eur Urol. 2010, 58: 900-905. 10.1016/j.eururo.2010.08.044.

    Article  PubMed  Google Scholar 

  18. 18.

    Imai E, Horio M, Yamagata K, Iseki K, Hara S, Ura N, Kiyohara Y, Makino H, Hishida A, Matsuo S: Slower decline of glomerular filtration rate in the Japanese general population: a longitudinal 10-year follow-up study. Hypertension Res. 2008, 31: 433-441. 10.1291/hypres.31.433.

    Article  Google Scholar 

  19. 19.

    Mooney JF, Ranasinghe I, Chow CK, Perkovic V, Barzi F, Zoungas S, Holzmann MJ, Welten GM, Biancari F, Wu VC, Tan TC, Cass A, Hillis GS: Preoperative estimates of glomerular filtration rate as predictors of outcome after surgery: a systematic review and meta-analysis. Anesthesiology. 2013, 118: 809-824. 10.1097/ALN.0b013e318287b72c.

    Article  PubMed  Google Scholar 

  20. 20.

    Ljungberg B, Hanbury DC, Kuczyk MA, Merseburger AS, Mulders PF, Patard JJ, Sinescu IC: Renal cell carcinoma guideline. Eur Urol. 2007, 51: 1502-1510. 10.1016/j.eururo.2007.03.035.

    Article  PubMed  Google Scholar 

  21. 21.

    Peycelon M, Hupertan V, Comperat E, Renard-Penna R, Vaessen C, Conort P, Bitker MO, Chartier-Kastler E, Richard F, Roupret M: Long-term outcomes after nephron sparing surgery for renal cell carcinoma larger than 4 cm. J Urol. 2009, 181: 35-41.

    Article  PubMed  Google Scholar 

  22. 22.

    Brookman-May S, Johannsen M, May M, Hoschke B, Gunschera J, Wieland WF, Burger M: Difference between clinical and pathologic renal tumor size, correlation with survival, and implications for patient counseling regarding nephron-sparing surgery. AJR Am J Roentgenol. 2011, 197: 1137-1145. 10.2214/AJR.11.6534.

    Article  PubMed  Google Scholar 

  23. 23.

    Novick AC, Streem SB: Surgery of the kidney. Campbell’s Urology. Edited by: Walsh PC, Retik AB, Stamey TA, Vaughan J. 1998, Philadelphia, PA: WB Saunders, 2973-3061. 7

    Google Scholar 

  24. 24.

    X-s C, Z-t Z, Du J, Bi X-c, Sun G, Yao X: Optimal surgical margin in nephron-sparing surgery for T1b renal cell carcinoma. Urology. 2012, 79: 836-839. 10.1016/j.urology.2011.11.023.

    Article  Google Scholar 

  25. 25.

    Li Q-L, Guan H-W, Zhang Q-P, Zhang L-Z, Wang F-P, Liu Y-J: Optimal margin in nephron-sparing surgery for renal cell carcinoma 4 cm or less. Eur Urol. 2003, 44: 448-451. 10.1016/S0302-2838(03)00310-5.

    Article  PubMed  Google Scholar 

  26. 26.

    Russo P: Commentary on: prospective study of safety margins in partial nephrectomy: intraoperative assessment and contribution of frozen section analysis: Timsit MO, Bazin JP, Thiounn N, Fontaine E, Chretien Y, Dufour B, Mejean A, Department of Urology, Hôpital Necker-Enfants Malades, Paris, France, Urology 2006, 67 923–926. Urol Oncol. 2006, 24: 559-560. 10.1016/j.urolonc.2006.08.005.

    Article  Google Scholar 

  27. 27.

    Lane BR, Gill IS, Fergany AF, Larson BT, Campbell SC: Limited warm ischemia during elective partial nephrectomy has only a marginal impact on renal functional outcomes. J Urol. 2011, 185: 1598-1603. 10.1016/j.juro.2010.12.046.

    Article  PubMed  Google Scholar 

  28. 28.

    Funahashi Y, Hattori R, Yamamoto T, Sassa N, Fujita T, Gotoh M: Effect of warm ischemia on renal function during partial nephrectomy: assessment with new 99mTc-mercaptoacetyltriglycine scintigraphy parameter. Urology. 2012, 79: 160-164. 10.1016/j.urology.2011.08.071.

    Article  PubMed  Google Scholar 

  29. 29.

    Gill IS, Eisenberg MS, Aron M, Berger A, Ukimura O, Patil MB, Campese V, Thangathurai D, Desai MM: ‘Zero ischemia’ partial nephrectomy: novel laparoscopic and robotic technique. Eur Urol. 2011, 59: 128-134. 10.1016/j.eururo.2010.10.002.

    Article  PubMed  Google Scholar 

  30. 30.

    Gill IS, Patil MB, de Castro Abreu AL, Ng C, Cai J, Berger A, Eisenberg MS, Nakamoto M, Ukimura O, Goh AC: Zero ischemia anatomical partial nephrectomy: a novel approach. J Urol. 2012, 187: 807-814. 10.1016/j.juro.2011.10.146.

    Article  PubMed  Google Scholar 

  31. 31.

    Simone G, Papalia R, Guaglianone S, Gallucci M: ‘Zero ischaemia’, sutureless laparoscopic partial nephrectomy for renal tumours with a low nephrometry score. BJU Int. 2012, 110: 124-130. 10.1111/j.1464-410X.2011.10782.x.

    Article  PubMed  Google Scholar 

  32. 32.

    Simone G, Papalia R, Guaglianone S, Carpanese L, Gallucci M: Zero ischemia laparoscopic partial nephrectomy after superselective transarterial tumor embolization for tumors with moderate nephrometry score: long-term results of a single-center experience. J Endourol. 2011, 25: 1443-1446. 10.1089/end.2010.0684.

    Article  PubMed  Google Scholar 

  33. 33.

    Simone G, Papalia R, Guaglianone S, Forestiere E, Gallucci M: Preoperative superselective transarterial embolization in laparoscopic partial nephrectomy: technique, oncologic, and functional outcomes. J Endourol. 2009, 23: 1473-1478. 10.1089/end.2009.0334.

    Article  PubMed  Google Scholar 

  34. 34.

    Lopera JE, Suri R, Kroma G, Gadani S, Dolmatch B: Traumatic occlusion and dissection of the main renal artery: endovascular treatment. J Vascul Int Radiol. 2011, 22: 1570-1574. 10.1016/j.jvir.2011.08.002.

    Article  Google Scholar 

  35. 35.

    Secin FP: Importance and limits of ischemia in renal partial surgery: experimental and clinical research. Advances Urol. 2008, 10.1155/2008/102461.

    Google Scholar 

  36. 36.

    Ward JP: Determination of the optimum temperature for regional renal hypothermia during temporary renal ischaemia. Bri J Urol. 1975, 47: 17-24. 10.1111/j.1464-410X.1975.tb03913.x.

    CAS  Article  Google Scholar 

  37. 37.

    Becker F, Van Poppel H, Hakenberg OW, Stief C, Gill I, Guazzoni G, Montorsi F, Russo P, Stöckle M: Assessing the impact of ischaemia time during partial nephrectomy. Eur Urol. 2009, 56: 625-635. 10.1016/j.eururo.2009.07.016.

    Article  PubMed  Google Scholar 

  38. 38.

    Novick A: Renal hypothermia: in vivo and ex vivo. Urologic Clin North Am. 1983, 10: 637-644.

    CAS  Google Scholar 

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Correspondence to Jun Qi.

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The authors declare that they have no competing interests.

Authors’ contributions

JQ, YY, and TH designed the study. QB and JK carried out the study and interpreted the results. JL and YW wrote the manuscript. All authors read and approved the final manuscript.

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Qi, J., Yu, Y., Huang, T. et al. Predictors of postoperative renal functional damage after nephron-sparing surgery. World J Surg Onc 11, 216 (2013).

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  • Glomerular filtration rate
  • nephron-sparing surgery
  • renal tumor
  • predictors