The effects of renal ischemia on kidney function in renal cancer conservative surgery

Over the past ten years nephron sparing surgery for renal cancer has been compared to radical nephrectomy for what concern oncological results, even in elective situations but it is necessary to consider functional results (renal function) as well. Clamping renal artery, inducing a temporary renal ischemia that might represent the major known cause of permanent renal damage, is advised for both open and laparoscopic conservative approach. Data from literature show that before the clamping, the patient should be adequately hydrated and receive mannitol. Ischemia should last preferentially less than 30 minutes and kidney cooling should be advised in case of more prolonged ischemia. Artery reclamping should be avoided. Both in warm and cold ischemia, the renal tissue should be perfused by mannitol once the circulation is resumed.