The latest research report ”Tolerance of the Human Kidney to Isolated Controlled Ischemia” that was compiled by Dr Parekh after his research study at the University of Texas Health Science Center at San Antonio is expected to change the future treatment modalities and outcome in kidney cancer patients. The report is published in renowned Journal of the American Society of Nephrology.
Kidney cancer treatment options in localized, early stages or small tumors are fairly limited due to risk of potential surgical clamping induced ischemia, especially in patients with one functional kidney or those who are at risk of developing damage to the normal kidney. Surgeons traditionally clamp the blood supply to the kidney for a period of 30 minutes safely while performing partial nephrectomy or nephron-sparing surgery (NSS).
However, the latest research conducted by Parekh – the Dr. Victor Politano Endowed Chair in Clinical Urology and Chief of Robotic Surgery – suggests that the clamping of the kidney blood supply can be prolonged for a period of 45 to 60 minutes without increasing any risk of ischemic injury.
Parekh and his team studied surgical clamping induced ischemia while performing renal biopsies before, during and after the clamping in 40 patients during partial nephrectomy procedure at the University of Texas Health Science Center at San Antonio. The team observed that in 82% of the patients, ischemia lasted for 30 minutes, but on serial assessment of renal tissues and ischemic bio-markers, it was identified that the renal functions did not correlate with the elevations in the serial biomarkers.
“No other study has prospectively looked at biomarkers in the setting of renal ischemia and correlated them with renal ultrastructure and used real-time biopsies to see whether the concern about ischemia was justified. Our findings suggest that human kidneys can safely tolerate 30 to 60 minutes of controlled clamp ischemia with only mild structural changes and no acute functional loss.”
Parekh suggested that this approach can give surgeons more functional independence to perform extensive surgeries to salvage non- cancerous tissue in localized renal malignancy. With an emergence of over 65,000 new renal carcinoma cases each year in U.S. alone (with many patients reported at an earlier stage due to advancements in scientific and radiological diagnostic modalities), it can be safely concluded that this approach will enable surgeons to save normal renal tissue in 80% cases by NSS (as opposed to only 25% NSS procedures performed currently due to time pressure and risk of significant renal ischemia).
Parekh further suggested:
“By showing that the blood vessels can be safely clamped for longer periods, our study should make NSS procedures more attractive to other surgeons in their own practices.”
Parekh in an expert urologist and is considered among the world’s leading and renowned robotic surgeons for urologic oncology.