Predictive Factors for Postoperative Renal Function After Off-Clamp, Non-Renorrhaphy Partial Nephrectomy

Predictive Factors for Postoperative Renal Function After Off-Clamp, Non-Renorrhaphy Partial Nephrectomy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Predictive Factors for Postoperative Renal Function After Off-Clamp, Non-Renorrhaphy Partial Nephrectomy Masaki Nakamura, Shuji Kameyama, Taro Teshima, Yasushi Inoue, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-871351/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: There is limited information on perioperative renal function during off-clamp, non-renorrhaphy open partial nephrectomy.Therefore, this study aimed to clarify the chronological postoperative changes in renal function after off-clamp, non-renorrhaphy open partial nephrectomy. Methods: Clinical records of 138 patients with renal tumors who underwent off-clamp, non-renorrhaphy open partial nephrectomy at our institution were reviewed. Off-clamp, non-renorrhaphy partial nephrectomy were performed using a soft coagulation system. Perioperativeestimated glomerular filtration rate (eGFR) preservation was calculated, and predictors were identified using multivariate regression analysis at 5 days, 1 month, and 3 months after surgery. Results: The median operation time was 122 minutes, and the median volume of estimated blood loss was155 mL. The mean eGFR preservation at 5 days, 1 month, and 3 months after surgery was 95.3%, 91.0%, and 90.7%, respectively. Multivariate regression analysis revealed that estimated blood loss was an independent predictor of perioperative eGFR preservation at 5 days and 1 month after surgery, while age was an independent predictor of perioperative eGFR preservation at 3months after surgery. Conclusion: Chronological changes in renal function after off-clamp, non-renorrhaphy open partial nephrectomy have been reported.Ourresults could bea reference in the era of robot-assisted partial nephrectomy. Oncology Renal pedicle clamping renorrhaphy partial nephrectomy estimated glomerular filtration rate early recovery Figures Figure 1 Introduction Partial nephrectomy has become the standard procedure for removing renal tumors. Robot-assisted partial nephrectomy (RAPN) has been established as a safe and minimally invasive procedure for tumors measuring < 40 mm [ 1 – 3 ]. Renal pedicle clamping and renorrhaphy are included in laparoscopic partial nephrectomy in most institutes. However, these operative procedures cause postoperative complications, such as renal function impairment or pseudoaneurysm, at a certain rate [ 4 ]. Preservation of estimated glomerular filtration rate [eGFR] and no chronic kidney disease [CKD] upgrading are important outcomes after RAPN [ 1 , 3 , 5 , 6 ]. Although studies have reported eGFR preservation after on-clamp partial nephrectomy with renorrhaphy (open or laparoscopic), limited studies have reported that after off-clamp open partial nephrectomy without renorrhaphy. In particular, assessment of renal function impairment at very early time points (< 3 months after surgery) is lacking. We retrospectively analyzed the perioperative data of 138 patients who underwent off-clamp open partial nephrectomy without renorrhaphy. The association between perioperative renal function preservation and tumor characteristics and patient characteristics was analyzed. Results Patient characteristics are described in Table 1 . There were 92 (66.7%) were male patients and 46 (33.3%) female patients. The median age and tumor size were 63 years (range, 27–89 years) and 28 mm (range, 7–110 mm), respectively. Among the tumors, 41 (29.7%) were > 50% exophytic, 62 (44.9%) were < 50% exophytic, and 35 (25.4%) were entirely endophytic. The median nephrometry score was 7 (range, 4–10). Table 1 Patient and tumor characteristics No. patients 138 Sex (%) Male 92 (66.7) Female 46 (33.3) Median age (range) 63 (27―89) Median BMI (range) 23.4 (14.6―38.9) No. tumor laterality (%) Right 69 (50.0) Left 69 (50.0) Median tumor size, mm (range) 28 (7―110) Median RENAL nephrometry score (range) 7 (4–10) Exophytic/Endophytic properties > 50% exophytic 41 (29.7) 50% of mass is across polar line or mass crosses the axial renal midline or mass is entirely between the polar lines 28 (20.3) Comorbidity, n (%) Hypertension 54 (39.1) Diabetes mellitus 22 (15.9) Dyslipidemia 17 (12.3)4 BMI Body Mass Index. The RENAL nephrometry score is the sum of the sectional scores (R, E, N, and L). RCC Renal cell carcinoma, The surgical results are described in Table 2 . The median operation time was 122.5 min. The median estimated blood loss was 155 mL. There were no cases of conversion to nephrectomy or consequential renal hilum clamping. The mean eGFR preservation at 5 days, 1 month, and 3 months after surgery was 95.3%, 91.0%, and 90.7%, respectively. The relationship between age and perioperative eGFR decline was shown in Fig. 1 A and 1 B. Statistically significant reduction in eGFR was detected only in patients aged over 80 (Fig. 1 A). Table 2 Surgical results and complications Median operative time, min (range) 122.5 (56-199) Median volume of estimated blood loss, mL (range) 155 (5-1070) No. additional resections 0 No. conversion to nephrectomy 0 Intraoperative blood transfusion 0 Postoperative blood transfusion 0 Pathology (%) Clear cell RCC 92 (66.7) Papillary RCC 13 (9.4) Chromophobe RCC 10 (7.2) Angiomyolipoma 17 (12.3) Oncocytoma 2 (1.4) Others 14 (10.1) Mean eGFR preservation, % (SD) Five days after surgery 95.3 (14.9) One month after surgery 91.0 (11.5) Three months after surgery 90.7 (16.3 eGFR estimated glomerular filtration ratio, RCC renal cell carcinoma Tumor size, R, N, RENAL score, and estimated blood loss were identified predictors of perioperative eGFR preservation at 5 days after surgery. Multivariate analysis revealed that estimated blood loss was an independent predictor of perioperative eGFR preservation (Table 3 ). Table 3 Predictors of perioperative eGFR preservation at 5 days after surgery. Univariate and multivariate analysis Univariate analysis Multivariate analysis Unstandardized regression coefficient B (95% CI) Standardized regression coefficient β p - value Unstandardized regression coefficient B (95% CI) Standardized regression coefficient β p - value Age † -0.128 (-0.332, 0.077) -0.105 0.219 -0.174 (-0.364, 0.017) -0.143 0.074 BMI -0.470 (-1.054, 0.114) -0.136 0.114 Tumour size † -0.218 (-0.356, -0.081) -0.261 0.02 * -0.101 (-0.247, 0.045) -0.121 0.172 R -6.417 (-11.209, -1.625) -0.221 0.009 * E -0.926 (-2.487, 4.339) -0.046 0.592 N † -3.752 (-6.615, -0.89) -0.217 0.011 L -2.435 (-5.923, 1.054) -0.118 0.17 RENAL score † -1.819 (-3.276, -0.362) -0.207 0.015 * -1.112 (-2.559, 0.335) -0.127 0.131 Operative time -0.055 (-0.132, 0.023) -0.118 0.168 eBlood loss † -0.024 (-0.033, -0.014) -0.377 < 0.001 * -0.019 (-0.03, -0.008) -0.3536 0.001 * HTN -3.198 (-8.356, 1.96) -0.105 0.222 DM -4.427 (-11.301, 2.446) -0.109 0.205 DL -1.052 (-8.751, 6.647) -0.023 0.787 eGFR estimated glomerular filtration rate, BMI body mass index. eBlood loss estimated blood loss, R Radius, E exophytic and endophytic properties, N Nearness of the tumor to the collecting system or sinus, L location relative to the upper and lower polar lines, (R,E,N, and L were scored according to RENAL nephrometry scoring system), HTN hypertension, DM diabetes mellitus, DL dyslypidemia, CI confidential interval, † These factors were put in multivariate regression analysis, * p-value < 0.05 was considered statistically significant. Tumor size, R, RENAL score, and estimated blood loss were identified as predictors of perioperative eGFR preservation at 1 month after surgery. Multivariate analysis revealed that age, tumor size, and estimated blood loss were independent predictors of the eGFR preservation (Table 4 ). Table 4 Predictors of perioperative eGFR preservation at 1 month after surgery. Results of univariate and multivariate analysis. Univariate analysis Multivariate analysis Unstandardized regression coefficient B (95% CI) Standardized regression coefficient β p - value Unstandardized regression coefficient B (95% CI) Standardized regression coefficient β p - value Age † -0.118 (-0.275, 0.039) -0.127 0.140 -0.158 (-0.307, -0.008) -0.17 0.039 * Sex 1.08 (-3.08, 5.239) 0.044 0.608 BMI -0.167 (-0.618, 0.285) -0.063 0.467 Tumour size † -0.182 (-0.287, -0.077) -0.283 0.001 * -0.121 (-0.235, -0.006) -0.187 0.039 * R -5.612 (-9.276, -1.948) -0.252 0.003 E † 0.441 (-2.204, 3.085) 0.028 0.742 N -2.187 (-4.425, 0.052) -0.164 0.055 L -1.597 (-4.302, 1.107) -0.1 0.245 RENAL score -1.277 (-2.404, -0.15) -0.189 0.027 * -0.769 (-1.902, 0.364) -0.114 0.182 Operative time -0.045 (-0.105, 0.015) -0.126 0.144 eBlood loss † -0.015 (-0.023, -0.007) -0.306 0.000 -0.01 (-0.018, -0.002) -0.209 0.018 * HTN -2.576 (-6.567, 1.415) -0.109 0.204 DM -1.976 (-7.393, 3.442) -0.062 0.472 DL -2.421 (-8.496, 3.653) -0.068 0.432 eGFR estimated glomerular filtration rate, BMI body mass index. eBlood loss estimated blood loss, R Radius, E exophytic and endophytic properties, N Nearness of the tumor to the collecting system or sinus, L location relative to the upper and lower polar lines, (R,E,N, and L were scored according to RENAL nephrometry scoring system), HTN hypertension, DM diabetes mellitus, DL dyslypidemia, CI confidential interval, † These factors were put in multivariate regression analysis, CI confidence interval, * p-value < 0.05 was considered statistically significant. Age, tumor size, R, N, and estimated blood loss were identified as predictors of perioperative eGFR preservation at 3 months after surgery. Multivariate analysis revealed that age was an independent predictor of perioperative eGFR preservation (Table 5 ). Table 5 Predictors of perioperative eGFR preservation at 3 months after surgery. Results of univariate and multivariate analysis. Univariate analysis Multivariate analysis Unstandardized regression coefficient B (95% CI) Standardized regression coefficient β p - value Unstandardized regression coefficient B (95% CI) Standardized regression coefficient β p - value Age † -0.228 (-0.449, 0.008) -0.173 0.043* -0.277 (-0.494, -0.059) -0.209 0.013 * Sex -1.981 (-7.853, 3.89) -0.057 0.506 BMI -0.073 (-0.727, 0.580) -0.019 0.824 Tumour size † -0.182 (-0.334, -0.03) -0.199 0.019* -0.277 (-0.494, 0.039) -0.139 0.133 R -6.019 (-11.274, -0.764) -0.191 0.025* E 0.706 (-3.014, 4.426) 0.032 0.708 N -3.058 (-6.21, 0.094) -0.162 0.057 L -1.474 (-5.292, 2.344) -0.065 0.446 RENAL score † -1.472 (-3.075, -0.13) -0.154 0.071 -1.113 (-2.764, 0.537) -0.116 0.184 Operative time 0.01 (-0.075, 0.095) 0.02 0.817 eBlood loss † -0.014 (-0.025, -0.003) -0.206 0.015* -0.009 (-0.021, 0.003) -0.128 0.156 HTN -3.94 (-9.549, 1.67) -0.118 0.167 DM -4.882 (-12.368, 2.604) -0.11 0.199 DL -1.584 (-9.969, 6.8) -0.032 0.709 eGFR estimated glomerular filtration rate, BMI body mass index. eBlood loss estimated blood loss, R Radius, E exophytic and endophytic properties, N Nearness of the tumor to the collecting system or sinus, L location relative to the upper and lower polar lines, (R, E, N, and L were scored according to RENAL nephrometry scoring system), HTN hypertension, DM diabetes mellitus, DL dyslypidemia, CI confidential interval, † These factors were put in multivariate regression analysis, * p-value < 0.05 was considered statistically significant. Discussion We have reported on perioperative renal function preservation during off-clamp, non-renorrhaphy open partial nephrectomy within 3 months after surgery. The advantage of the off-clamp technique in perioperative renal function preservation is controversial. Wen et al. have reported less decrease in renal function in off-clamp surgery compared to that in on-clamp surgery (weighted mean difference: 4.81 mL/min/1.73 m 2 ; 95% confidence interval: 3.53–6.08; p < 0.00001) [ 9 ]. Meanwhile, several studies have failed to show the advantages of off-clamp surgery in eGFR preservation over clamping surgery in pneumoperitoneum settings [ 10 – 13 ]. AS for the advantage of renorrhaphy, the non-renorrhaphy technique failed to benefit the preservation of perioperative renal function for ≥ T1b renal tumors in open partial nephrectomy compared with the cold ischemia technique [ 14 ]. In this study, the renal function was analyzed at 4 and 6 months after surgery. However, studies comparing single-layered and double-layered renorrhaphy have shown the benefits of single-layered renorrhaphy in eGFR preservation [ 4 , 15 , 16 ]. In these analyses, eGFR was assessed between the date of discharge and 1 month postoperatively. Considering these findings, it is possible that omission of renorrhaphy preserves renal function during the early postoperative period. The RENAL score correlates with perioperative reduction in renal function during on-clamp partial nephrectomy [ 17 ]. In this study, split renal function was measured using diethylene triamine penta-acetic acid scintigraphy, which showed a significant decrease in ipsilateral renal function 6 months after surgery, with no significant change thereafter [ 17 ]. There are limited data on perioperative renal function during combined off-clamp and non-renorrhaphy partial nephrectomy. We have recently reported the surgical results of off-clamp, non-renorrhaphy open partial nephrectomy for ≥ T1b renal tumors [ 8 ]. The perioperative eGFR preservation at 1 month and 3 months after surgery was 88.9% and 87.3%, respectively [ 8 ]. In laparoscopic or robotic surgeries, perioperative eGFR preservation was 96.9–100% for highly selected patients [ 18 , 19 ]. In our study, the eGFR preservation at 5 days, 1 month, and 3 months after surgery was 95.3%, 91.0%, and 90.7%, respectively. We believe our report will add some knowledge on the chronological recovery of renal function after off-clamp, non-renorrhaphy partial nephrectomy. Estimated blood loss was an early predictor of perioperative eGFR preservation, but was replaced by age at 3 months after surgery. Within 1 month after surgery, we assumed that damage of renal parenchyma by soft coagulation directly contributed to the decrease in the eGFR. Impairment of the potential for renal function recovery by age may affect eGFR preservation > 3 months after surgery [ 20 ]. This study has some limitations. First, the study was a retrospective study. Second, the postoperative eGFR was analyzed only within 3 months after surgery. In conclusion, we have analyzed perioperative changes in renal function after off-clamp, non-renorrhaphy open partial nephrectomy until 3 months after surgery. The perioperative eGFR preservation rates of 95.3%, 91.0%, and 90.7% at 5 days, 1 month, and 3 months after surgery, respectively, reported in our study may be used as reference in the era of RAPN. Methods Patients Among 220 patients with renal tumors who underwent off-clamp, non-renorrhaphy open partial nephrectomy at our institute between 2013 and 2020, those with postoperative complications of urinoma or incomplete data were excluded. Therefore, clinical records of 138 patients were retrospectively analyzed. Surgical Techniques Complexity of renal tumors were analyzed according to R-E-N-A-L nephrometry scoring system [ 7 ]. Briefly, (R)adius (tumor size as maximal diameter), (E)xophytic and endophytic properties, (N)earness of the tumor to the collecting system or sinus, and (L)ocation relative to the upper and lower polar lines were scored on a 1, 2 or 3-point scale. RENAL score represents sum of R, E, N, and L scores. All patients underwent open partial nephrectomy retroperitoneally. Renal pedicle was not secured, and renal pedicle clamping and cortical renorrhaphy were omitted. We used monopolar SOFT COAG (VIO300D, ERBE, Germany) with a normal saline drip for hemostasis. Surgical techniques have been described previously [ 8 ]. In partial nephrectomy, the renal parenchyma was repeatedly separated bluntly using a spatula-shaped tip of a monopolar device, followed by soft coagulation of the separated renal parenchyma and bleeding blood vessels. To minimize blood loss, tumor resection was advanced by millimeter unit. Resection beds were sutured with 4 − 0 VICRYL® when the collecting system was opened. Urine leakage was ruled out by intravenous injection of indigo carmine solution. TachoSil® was placed on the resection surface to ensure hemostasis. Assessment of renal function and perioperative reduction in renal function The eGFR was calculated using the Eq. 186 × (Creatinine/88.4) −1.154 × (Age) −0.203 × (0.742 if female). Perioperative eGFR preservation at 5 days, 1 month, and 3 months after surgery was calculated as postoperative eGFR/preoperative eGFR × 100 (%). Statistical analysis The Student’s t-test was used to analyze continuous variables. Univariate and multivariate regression analyses were performed to identify predictors of postoperative eGFR preservation. Statistical significance was set at p < 0.05. All statistical analyses were performed using the SPSS version 24. Declarations Author contributions Data collection: M.N., Y.A.; Writing - original draft preparation: M.N.; Writing - review and editing: M.N., S.K., T.T., Y.I., T.Y., Y.A., N.S., H.I., R.A., S.I., M.K., T.M., Y.S.; Supervision: S.K., Y.S. Statement of Ethics This study was approved by the Ethics Committee of NTT Medical Center, Tokyo (ID: 20-198), and was conducted in accordance with the Helsinki Declaration. Informed consent was obtained in the form of opt-out on the web-site (https://www.nmct.ntt-east.co.jp/aboutus/ethic/research/). Those who rejected were excluded. Conflict ofInterest Statement The authors declare no competing interests. Funding Sources This research received no specific grantfrom any funding agency in the public, commercial, or not-for-profit sectors. Data Availability Statement All data generated or analysed during this study are included in this article. Further enquiries can be directed to the corresponding author. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-871351","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":50295749,"identity":"ceaffaef-50c7-43e1-9dbd-8a044b40c309","order_by":0,"name":"Masaki 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Tokyo","correspondingAuthor":false,"prefix":"","firstName":"Yoshiki","middleName":"","lastName":"Ambe","suffix":""},{"id":50295755,"identity":"79a8a833-a677-48a0-8bd2-548d91f08f2a","order_by":6,"name":"Norihide Shirakawa","email":"","orcid":"","institution":"NTT Medical Center Tokyo","correspondingAuthor":false,"prefix":"","firstName":"Norihide","middleName":"","lastName":"Shirakawa","suffix":""},{"id":50295756,"identity":"83144a62-16d2-4757-b609-08004f28ad7d","order_by":7,"name":"Hiroki Inatsu","email":"","orcid":"","institution":"NTT Medical Center Tokyo","correspondingAuthor":false,"prefix":"","firstName":"Hiroki","middleName":"","lastName":"Inatsu","suffix":""},{"id":50295757,"identity":"a9869a22-fa48-4f70-ade6-d5b264da0fe5","order_by":8,"name":"Ryo Amakawa","email":"","orcid":"","institution":"NTT Medical Center Tokyo","correspondingAuthor":false,"prefix":"","firstName":"Ryo","middleName":"","lastName":"Amakawa","suffix":""},{"id":50295758,"identity":"58b07cc3-e9b9-4236-a05d-191ba6aa9c95","order_by":9,"name":"Shunsuke Imai","email":"","orcid":"","institution":"NTT Medical Center Tokyo","correspondingAuthor":false,"prefix":"","firstName":"Shunsuke","middleName":"","lastName":"Imai","suffix":""},{"id":50295759,"identity":"b649e387-996e-4ee9-ac8b-03f238e3f058","order_by":10,"name":"Masashi Kusakabe","email":"","orcid":"","institution":"NTT Medical Center Tokyo","correspondingAuthor":false,"prefix":"","firstName":"Masashi","middleName":"","lastName":"Kusakabe","suffix":""},{"id":50295760,"identity":"bee24195-0781-461e-96e7-eb2fdeee0bef","order_by":11,"name":"Teppei Morikawa","email":"","orcid":"","institution":"NTT Medical Center Tokyo","correspondingAuthor":false,"prefix":"","firstName":"Teppei","middleName":"","lastName":"Morikawa","suffix":""},{"id":50295761,"identity":"710c3520-ee65-4c12-91c6-4618a9b39f5c","order_by":12,"name":"Yoshiyuki Shiga","email":"","orcid":"","institution":"NTT Medical Center Tokyo","correspondingAuthor":false,"prefix":"","firstName":"Yoshiyuki","middleName":"","lastName":"Shiga","suffix":""}],"badges":[],"createdAt":"2021-09-03 03:44:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-871351/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-871351/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13201736,"identity":"cf279a78-21fe-424c-b09e-c2fe9d0426ac","added_by":"auto","created_at":"2021-09-08 22:29:46","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":41326,"visible":true,"origin":"","legend":"A) Relationship between age and eGFR change was shown. N.S. not significant. * p \u003c 0.05.\nB) Chronological change of eGFR (mean) by age are plotted.","description":"","filename":"fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-871351/v1/eab3b95925e01b238792170b.png"},{"id":20457984,"identity":"d3989643-24b7-4003-9c81-4604f38e1774","added_by":"auto","created_at":"2022-04-18 14:44:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":366073,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-871351/v1/b6be6593-4976-485c-8374-cd0b131f8963.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003ePredictive Factors for Postoperative Renal Function After Off-Clamp, Non-Renorrhaphy Partial Nephrectomy\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePartial nephrectomy has become the standard procedure for removing renal tumors. Robot-assisted partial nephrectomy (RAPN) has been established as a safe and minimally invasive procedure for tumors measuring\u0026thinsp;\u0026lt;\u0026thinsp;40 mm [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Renal pedicle clamping and renorrhaphy are included in laparoscopic partial nephrectomy in most institutes. However, these operative procedures cause postoperative complications, such as renal function impairment or pseudoaneurysm, at a certain rate [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePreservation of estimated glomerular filtration rate [eGFR] and no chronic kidney disease [CKD] upgrading are important outcomes after RAPN [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Although studies have reported eGFR preservation after on-clamp partial nephrectomy with renorrhaphy (open or laparoscopic), limited studies have reported that after off-clamp open partial nephrectomy without renorrhaphy. In particular, assessment of renal function impairment at very early time points (\u0026lt;\u0026thinsp;3 months after surgery) is lacking.\u003c/p\u003e \u003cp\u003eWe retrospectively analyzed the perioperative data of 138 patients who underwent off-clamp open partial nephrectomy without renorrhaphy. The association between perioperative renal function preservation and tumor characteristics and patient characteristics was analyzed.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003ePatient characteristics are described in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. There were 92 (66.7%) were male patients and 46 (33.3%) female patients. The median age and tumor size were 63 years (range, 27\u0026ndash;89 years) and 28 mm (range, 7\u0026ndash;110 mm), respectively. Among the tumors, 41 (29.7%) were \u0026gt;\u0026thinsp;50% exophytic, 62 (44.9%) were \u0026lt;\u0026thinsp;50% exophytic, and 35 (25.4%) were entirely endophytic. The median nephrometry score was 7 (range, 4\u0026ndash;10).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient and tumor characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo. patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92 (66.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (33.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian age (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63 (27―89)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian BMI (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.4 (14.6―38.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo. tumor laterality (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69 (50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69 (50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian tumor size, mm (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (7―110)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian RENAL nephrometry score (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (4\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExophytic/Endophytic properties\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;50% exophytic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (29.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;50% exophytic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62 (44.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEntirely endophytic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (25.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocation relative to the polar lines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEntirely above the upper or below the lower polar line\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (33.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLesion crosses polar line\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64 (46.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt; 50% of mass is across polar line or mass crosses the axial renal midline or mass is entirely between the polar lines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (20.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidity, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54 (39.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (15.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyslipidemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (12.3)4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eBMI Body Mass Index. The RENAL nephrometry score is the sum of the sectional scores (R, E, N, and L). RCC Renal cell carcinoma,\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe surgical results are described in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The median operation time was 122.5 min. The median estimated blood loss was 155 mL. There were no cases of conversion to nephrectomy or consequential renal hilum clamping. The mean eGFR preservation at 5 days, 1 month, and 3 months after surgery was 95.3%, 91.0%, and 90.7%, respectively. The relationship between age and perioperative eGFR decline was shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA and \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB. Statistically significant reduction in eGFR was detected only in patients aged over 80 (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSurgical results and complications\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian operative time, min (range)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e122.5 (56-199)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian volume of estimated blood loss, mL (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e155 (5-1070)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo. additional resections\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo. conversion to nephrectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative blood transfusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative blood transfusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePathology (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClear cell RCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92 (66.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePapillary RCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (9.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChromophobe RCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (7.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAngiomyolipoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (12.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOncocytoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (10.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean eGFR preservation, % (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFive days after surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95.3 (14.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne month after surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91.0 (11.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThree months after surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90.7 (16.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeGFR estimated glomerular filtration ratio, RCC renal cell carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTumor size, R, N, RENAL score, and estimated blood loss were identified predictors of perioperative eGFR preservation at 5 days after surgery. Multivariate analysis revealed that estimated blood loss was an independent predictor of perioperative eGFR preservation (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePredictors of perioperative eGFR preservation at 5 days after surgery. Univariate and multivariate analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnivariate analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eMultivariate analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnstandardized regression coefficient B (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStandardized regression coefficient β\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep -\u003c/em\u003evalue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUnstandardized regression coefficient B (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eStandardized regression coefficient β\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ep -\u003c/em\u003evalue\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.128 (-0.332, 0.077)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.174 (-0.364, 0.017)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.074\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.470 (-1.054, 0.114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumour size\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.218 (-0.356, -0.081)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.02\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.101 (-0.247, 0.045)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.172\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-6.417 (-11.209, -1.625)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.009\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.926 (-2.487, 4.339)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.592\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-3.752 (-6.615, -0.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.217\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2.435 (-5.923, 1.054)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRENAL score\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.819 (-3.276, -0.362)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.015\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.112 (-2.559, 0.335)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.131\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperative time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.055 (-0.132, 0.023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeBlood loss\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.024 (-0.033, -0.014)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.019 (-0.03, -0.008)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.3536\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHTN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-3.198 (-8.356, 1.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-4.427 (-11.301, 2.446)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.052 (-8.751, 6.647)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.787\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eeGFR estimated glomerular filtration rate, BMI body mass index. eBlood loss estimated blood loss, R Radius, E exophytic and endophytic properties, N Nearness of the tumor to the collecting system or sinus, L location relative to the upper and lower polar lines, (R,E,N, and L were scored according to RENAL nephrometry scoring system), HTN hypertension, DM diabetes mellitus, DL dyslypidemia, CI confidential interval, \u003csup\u003e\u0026dagger;\u003c/sup\u003e These factors were put in multivariate regression analysis, * p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTumor size, R, RENAL score, and estimated blood loss were identified as predictors of perioperative eGFR preservation at 1 month after surgery. Multivariate analysis revealed that age, tumor size, and estimated blood loss were independent predictors of the eGFR preservation (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePredictors of perioperative eGFR preservation at 1 month after surgery. Results of univariate and multivariate analysis.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnivariate analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eMultivariate analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnstandardized regression coefficient B (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStandardized regression coefficient β\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep -\u003c/em\u003evalue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUnstandardized regression coefficient B (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eStandardized regression coefficient β\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ep -\u003c/em\u003evalue\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.118 (-0.275, 0.039)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.158 (-0.307, -0.008)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.039\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.08 (-3.08, 5.239)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.608\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.167 (-0.618, 0.285)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.063\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.467\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumour size\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.182 (-0.287, -0.077)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.283\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.121 (-0.235, -0.006)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.039\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-5.612 (-9.276, -1.948)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.252\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eE\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.441 (-2.204, 3.085)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.742\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2.187 (-4.425, 0.052)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.055\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.597 (-4.302, 1.107)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRENAL score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.277 (-2.404, -0.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.027\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.769 (-1.902, 0.364)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.182\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperative time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.045 (-0.105, 0.015)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeBlood loss\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.015 (-0.023, -0.007)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.306\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.01 (-0.018, -0.002)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.018\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHTN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2.576 (-6.567, 1.415)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.976 (-7.393, 3.442)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.472\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2.421 (-8.496, 3.653)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.068\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.432\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eeGFR estimated glomerular filtration rate, BMI body mass index. eBlood loss estimated blood loss, R Radius, E exophytic and endophytic properties, N Nearness of the tumor to the collecting system or sinus, L location relative to the upper and lower polar lines, (R,E,N, and L were scored according to RENAL nephrometry scoring system), HTN hypertension, DM diabetes mellitus, DL dyslypidemia, CI confidential interval,\u003csup\u003e\u0026dagger;\u003c/sup\u003e These factors were put in multivariate regression analysis, CI confidence interval, * p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAge, tumor size, R, N, and estimated blood loss were identified as predictors of perioperative eGFR preservation at 3 months after surgery. Multivariate analysis revealed that age was an independent predictor of perioperative eGFR preservation (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePredictors of perioperative eGFR preservation at 3 months after surgery. Results of univariate and multivariate analysis.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnivariate analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eMultivariate analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnstandardized regression coefficient B (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStandardized regression coefficient β\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep -\u003c/em\u003evalue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUnstandardized regression coefficient B (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eStandardized regression coefficient β\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ep -\u003c/em\u003evalue\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.228 (-0.449, 0.008)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.043*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.277 (-0.494, -0.059)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.013\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.981 (-7.853, 3.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.506\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.073 (-0.727, 0.580)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.824\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumour size\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.182 (-0.334, -0.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.019*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.277 (-0.494, 0.039)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.133\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-6.019 (-11.274, -0.764)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.191\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.025*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.706 (-3.014, 4.426)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.708\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-3.058 (-6.21, 0.094)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.474 (-5.292, 2.344)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.446\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRENAL score\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.472 (-3.075, -0.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.113 (-2.764, 0.537)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.184\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperative time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.01 (-0.075, 0.095)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.817\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eeBlood loss\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.014 (-0.025, -0.003)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.015*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.009 (-0.021, 0.003)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.156\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHTN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-3.94 (-9.549, 1.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-4.882 (-12.368, 2.604)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.584 (-9.969, 6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.709\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eeGFR estimated glomerular filtration rate, BMI body mass index. eBlood loss estimated blood loss, R Radius, E exophytic and endophytic properties, N Nearness of the tumor to the collecting system or sinus, L location relative to the upper and lower polar lines, (R, E, N, and L were scored according to RENAL nephrometry scoring system), HTN hypertension, DM diabetes mellitus, DL dyslypidemia, CI confidential interval, \u003csup\u003e\u0026dagger;\u003c/sup\u003e These factors were put in multivariate regression analysis, * p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe have reported on perioperative renal function preservation during off-clamp, non-renorrhaphy open partial nephrectomy within 3 months after surgery.\u003c/p\u003e \u003cp\u003eThe advantage of the off-clamp technique in perioperative renal function preservation is controversial. Wen et al. have reported less decrease in renal function in off-clamp surgery compared to that in on-clamp surgery (weighted mean difference: 4.81 mL/min/1.73 m\u003csup\u003e2\u003c/sup\u003e; 95% confidence interval: 3.53\u0026ndash;6.08; p\u0026thinsp;\u0026lt;\u0026thinsp;0.00001) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Meanwhile, several studies have failed to show the advantages of off-clamp surgery in eGFR preservation over clamping surgery in pneumoperitoneum settings [\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAS for the advantage of renorrhaphy, the non-renorrhaphy technique failed to benefit the preservation of perioperative renal function for \u0026ge;\u0026thinsp;T1b renal tumors in open partial nephrectomy compared with the cold ischemia technique [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In this study, the renal function was analyzed at 4 and 6 months after surgery. However, studies comparing single-layered and double-layered renorrhaphy have shown the benefits of single-layered renorrhaphy in eGFR preservation [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In these analyses, eGFR was assessed between the date of discharge and 1 month postoperatively. Considering these findings, it is possible that omission of renorrhaphy preserves renal function during the early postoperative period.\u003c/p\u003e \u003cp\u003eThe RENAL score correlates with perioperative reduction in renal function during on-clamp partial nephrectomy [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In this study, split renal function was measured using diethylene triamine penta-acetic acid scintigraphy, which showed a significant decrease in ipsilateral renal function 6 months after surgery, with no significant change thereafter [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere are limited data on perioperative renal function during combined off-clamp and non-renorrhaphy partial nephrectomy. We have recently reported the surgical results of off-clamp, non-renorrhaphy open partial nephrectomy for \u0026ge;\u0026thinsp;T1b renal tumors [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The perioperative eGFR preservation at 1 month and 3 months after surgery was 88.9% and 87.3%, respectively [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In laparoscopic or robotic surgeries, perioperative eGFR preservation was 96.9\u0026ndash;100% for highly selected patients [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In our study, the eGFR preservation at 5 days, 1 month, and 3 months after surgery was 95.3%, 91.0%, and 90.7%, respectively. We believe our report will add some knowledge on the chronological recovery of renal function after off-clamp, non-renorrhaphy partial nephrectomy.\u003c/p\u003e \u003cp\u003eEstimated blood loss was an early predictor of perioperative eGFR preservation, but was replaced by age at 3 months after surgery. Within 1 month after surgery, we assumed that damage of renal parenchyma by soft coagulation directly contributed to the decrease in the eGFR. Impairment of the potential for renal function recovery by age may affect eGFR preservation\u0026thinsp;\u0026gt;\u0026thinsp;3 months after surgery [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study has some limitations. First, the study was a retrospective study. Second, the postoperative eGFR was analyzed only within 3 months after surgery.\u003c/p\u003e \u003cp\u003eIn conclusion, we have analyzed perioperative changes in renal function after off-clamp, non-renorrhaphy open partial nephrectomy until 3 months after surgery. The perioperative eGFR preservation rates of 95.3%, 91.0%, and 90.7% at 5 days, 1 month, and 3 months after surgery, respectively, reported in our study may be used as reference in the era of RAPN.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u003c/h2\u003e \u003cp\u003eAmong 220 patients with renal tumors who underwent off-clamp, non-renorrhaphy open partial nephrectomy at our institute between 2013 and 2020, those with postoperative complications of urinoma or incomplete data were excluded. Therefore, clinical records of 138 patients were retrospectively analyzed.\u003c/p\u003e \u003c/div\u003e\n\u003ch2\u003eSurgical Techniques\u003c/h2\u003e\n\u003cp\u003eComplexity of renal tumors were analyzed according to R-E-N-A-L nephrometry scoring system [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Briefly, (R)adius (tumor size as maximal diameter), (E)xophytic and endophytic properties, (N)earness of the tumor to the collecting system or sinus, and (L)ocation relative to the upper and lower polar lines were scored on a 1, 2 or 3-point scale. RENAL score represents sum of R, E, N, and L scores. All patients underwent open partial nephrectomy retroperitoneally. Renal pedicle was not secured, and renal pedicle clamping and cortical renorrhaphy were omitted. We used monopolar SOFT COAG (VIO300D, ERBE, Germany) with a normal saline drip for hemostasis. Surgical techniques have been described previously [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In partial nephrectomy, the renal parenchyma was repeatedly separated bluntly using a spatula-shaped tip of a monopolar device, followed by soft coagulation of the separated renal parenchyma and bleeding blood vessels. To minimize blood loss, tumor resection was advanced by millimeter unit. Resection beds were sutured with 4\u0026thinsp;\u0026minus;\u0026thinsp;0 VICRYL\u0026reg; when the collecting system was opened. Urine leakage was ruled out by intravenous injection of indigo carmine solution. TachoSil\u0026reg; was placed on the resection surface to ensure hemostasis.\u003c/p\u003e \u003cp\u003e \u003cb\u003eAssessment of renal function and perioperative reduction in renal function\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe eGFR was calculated using the Eq.\u0026nbsp;186 \u0026times; (Creatinine/88.4)\u003csup\u003e\u0026minus;1.154\u003c/sup\u003e \u0026times; (Age)\u003csup\u003e\u0026minus;0.203\u003c/sup\u003e \u0026times; (0.742 if female). Perioperative eGFR preservation at 5 days, 1 month, and 3 months after surgery was calculated as postoperative eGFR/preoperative eGFR \u0026times; 100 (%).\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe Student\u0026rsquo;s t-test was used to analyze continuous variables. Univariate and multivariate regression analyses were performed to identify predictors of postoperative eGFR preservation. Statistical significance was set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05. All statistical analyses were performed using the SPSS version 24.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData collection: M.N., Y.A.; Writing - original draft preparation: M.N.; Writing - review and editing: M.N., S.K., T.T., Y.I., T.Y., Y.A., N.S., H.I., R.A., S.I., M.K., T.M., Y.S.; Supervision: S.K., Y.S.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatement of Ethics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of NTT Medical Center, Tokyo (ID: 20-198), and was conducted in accordance with the Helsinki Declaration.\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained in the form of opt-out on the web-site (https://www.nmct.ntt-east.co.jp/aboutus/ethic/research/). Those who rejected were excluded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict ofInterest Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Sources\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grantfrom any funding agency in the public, commercial, or\u003c/p\u003e\n\u003cp\u003enot-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this article. Further enquiries can be directed to the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSri D, Thakkar R, Patel HR,et al(2020) Robotic-assisted partial nephrectomy (RAPN) and standardization of outcome reporting: a prospective, observational study on reaching the \u0026ldquo;Trifecta and Pentafecta\u0026rdquo;. J Robot Surg doi: 10.1007/s11701-020-01141-z\u003c/li\u003e\n\u003cli\u003eGrivas N, Kalampokis N, Larcher A,et al (2019) Robot-assisted versus open partial nephrectomy: comparison of outcomes. A systematic review. Minerva UrolNefrol71:113\u0026ndash;120. doi: 10.23736/S0393-2249.19.03391-5\u003c/li\u003e\n\u003cli\u003eFurukawa J,Kanayama H, Azuma H, et al (2020) \u0026lsquo;Trifecta\u0026rsquo; outcomes of robot-assisted partial nephrectomy: a large Japanese multicentre study. Int J Clin Oncol25:347\u0026ndash;353. doi: 10.1007/s10147-019-01565-0\u003c/li\u003e\n\u003cli\u003eBertolo R, Campi R, Mir MC,et al (2019) Systematic review and pooled analysis of the impact of renorrhaphy techniques on renal functional outcome after partial nephrectomy. Eur Urol Oncol2:572\u0026ndash;575 doi: 10.1016/j.euo.2018.11.008\u003c/li\u003e\n\u003cli\u003eBravi CA, Larcher A, Capitanio U,et al(2021) Perioperative outcomes of open, laparoscopic, and robotic partial nephrectomy: a prospective multicenter observational study (the Record 2 project). Eur Urol Focus 7:390\u0026ndash;396. doi: 10.1016/j.euf.2019.10.013\u003c/li\u003e\n\u003cli\u003eMinervini A, Campi R, Lane BR,et al (2020) Impact of resection technique on perioperative outcomes and surgical margins after partial nephrectomy for localized renal masses: a prospective multicenter study. J Urol203:496\u0026ndash;504. doi: 10.1097/JU.0000000000000591\u003c/li\u003e\n\u003cli\u003eA. Kutikov and R. G. Uzzo. (2009) The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol\u003cem\u003e, \u003c/em\u003evol. 182, no. 3, pp. 844-53, doi: 10.1016/j.juro.2009.05.035.\u003c/li\u003e\n\u003cli\u003eNakamura M,Ambe Y, Teshima T,et al.(2021) Assessment of surgical outcomes of off-clamp open partial nephrectomy without renorrhaphy for \u0026ge;T1b renal tumours. Int J Clin Oncol. doi: 10.1007/s10147-021-01966-0\u003c/li\u003e\n\u003cli\u003eDeng W, Liu X, Hu J, et al (2018) Off-clamp partial nephrectomy has a positive impact on short- and long-term renal function: a systematic review and meta-analysis. BMC Nephrol19:188. doi: 10.1186/s12882-018-0993-3\u003c/li\u003e\n\u003cli\u003eAntonelli A, Veccia A, Francavilla S,et al (2019) On-clamp versus off-clamp robotic partial nephrectomy: a systematic review and meta-analysis. Urologia86:52\u0026ndash;62. doi: 10.1177/0391560319847847\u003c/li\u003e\n\u003cli\u003eAnderson BG,Potretzke AM, Du K,et al (2019) Comparing off-clamp and on-clamp robot-assisted partial nephrectomy: a prospective randomized trial. Urology126:102\u0026ndash;109. doi: 10.1016/j.urology.2018.11.053\u003c/li\u003e\n\u003cli\u003eKreshover JE, Kavoussi LR, Richstone L (2013) Hilar clamping versus off-clamp laparoscopic partial nephrectomy for T1b tumors. CurrOpinUrol23:399\u0026ndash;402 doi: 10.1097/MOU.0b013e3283632115\u003c/li\u003e\n\u003cli\u003eAnderson BG, Potretzke AM, Du K, et al (2018) Off-clamp robot-assisted partial nephrectomy does not benefit short-term renal function: a matched cohort analysis. J Robot Surg12:401\u0026ndash;407. doi: 10.1007/s11701-017-0745-6\u003c/li\u003e\n\u003cli\u003eTakagi T, Kondo T, Omae K\u003cem\u003e, \u003c/em\u003eet al (2015) Assessment of surgical outcomes of the non-renorrhaphy technique in open partial nephrectomy for \u0026ge;T1b renal tumors. Urology86:529\u0026ndash;533. doi: 10.1016/j.urology.2015.05.018\u003c/li\u003e\n\u003cli\u003eBahler CD, Cary KC, Garg S,et al (2015) Differentiating reconstructive techniques in partial nephrectomy: a propensity score analysis. Can J Urol22:7788\u0026ndash;7796.\u003c/li\u003e\n\u003cli\u003eBahler CD,Dube HT, Flynn KJ,et al (2015) Feasibility of omitting cortical renorrhaphy during robot-assisted partial nephrectomy: a matched analysis. J Endourol29:548\u0026ndash;555. doi: 10.1089/end.2014.0763\u003c/li\u003e\n\u003cli\u003eKwon T, Jeong IG, Ryu J, et al (2015) Renal function is associated with nephrometry score after partial nephrectomy: a study using diethylene triamine penta-acetic acid (DTPA) renal scanning. Ann Surg Oncol22 Suppl 3:S1594\u0026ndash;S1600. doi: 10.1245/s10434-015-4500-9\u003c/li\u003e\n\u003cli\u003eTohi Y, Makita N, Suzuki I,et al (2018) \u0026ldquo;Off-clamp, non-renorrhaphy robot-assisted partial nephrectomy: an initial experience in a single institution. Hinyokika Kiyo64:323\u0026ndash;327. doi: 10.14989/ActaUrolJap_64_8_323\u003c/li\u003e\n\u003cli\u003eSimone G, Papalia R, Guaglianone S, et al (2012) \u0026lsquo;Zero ischaemia\u0026rsquo;, sutureless laparoscopic partial nephrectomy for renal tumours with a low nephrometry score. BJU Int110:124\u0026ndash;130. doi: 10.1111/j.1464-410X.2011.10782.x\u003c/li\u003e\n\u003cli\u003eDenic A, Glassock RJ, Rule AD (2016) Structural and functional changes with the aging kidney. Adv Chronic Kidney Dis23:19\u0026ndash;28. doi: 10.1053/j.ackd.2015.08.004\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Renal pedicle clamping, renorrhaphy, partial nephrectomy, estimated glomerular filtration rate, early recovery","lastPublishedDoi":"10.21203/rs.3.rs-871351/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-871351/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThere is limited information on perioperative renal function during off-clamp, non-renorrhaphy open partial nephrectomy.Therefore, this study aimed to clarify the chronological postoperative changes in renal function after off-clamp, non-renorrhaphy open partial nephrectomy.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eClinical records of 138 patients with renal tumors who underwent off-clamp, non-renorrhaphy open partial nephrectomy at our institution were reviewed. Off-clamp, non-renorrhaphy partial nephrectomy were performed using a soft coagulation system. Perioperativeestimated glomerular filtration rate (eGFR) preservation was calculated, and predictors were identified using multivariate regression analysis at 5 days, 1 month, and 3 months after surgery.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe median operation time was 122 minutes, and the median volume of estimated blood loss was155 mL. The mean eGFR preservation at 5 days, 1 month, and 3 months after surgery was 95.3%, 91.0%, and 90.7%, respectively. Multivariate regression analysis revealed that estimated blood loss was an independent predictor of perioperative eGFR preservation at 5 days and 1 month after surgery, while age was an independent predictor of perioperative eGFR preservation at 3months after surgery.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eChronological changes in renal function after off-clamp, non-renorrhaphy open partial nephrectomy have been reported.Ourresults could bea reference in the era of robot-assisted partial nephrectomy.\u003c/p\u003e","manuscriptTitle":"Predictive Factors for Postoperative Renal Function After Off-Clamp, Non-Renorrhaphy Partial Nephrectomy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-09-08 22:29:44","doi":"10.21203/rs.3.rs-871351/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0e3c2f82-eeb8-4786-9cc5-e6c657687e59","owner":[],"postedDate":"September 8th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":7021880,"name":"Oncology"}],"tags":[],"updatedAt":"2022-04-18T14:44:18+00:00","versionOfRecord":[],"versionCreatedAt":"2021-09-08 22:29:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-871351","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-871351","identity":"rs-871351","version":["v1"]},"buildId":"J0_U0BvcaRcwD8yVFaRlm","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}