Renal Hypothermia During Partial Nephrectomy
- Full Text View
- Tabular View
- No Study Results Posted
- Disclaimer
- How to Read a Study Record
Purpose
The Objective is to determine if renal hypothermia during open partial nephrectomy results in improved post-operative renal function compared to warm ischemia.
Primary Aim is to determine the effect of hypothermia on preservation of overall renal function compared to no hypothermia in patients who require hilar vessel clamping during open partial nephrectomy for a renal tumor.
Hypothesis: Hypothermia will result in improved post-operative preservation of overall renal function.
Secondary Aim is to determine the effect of hypothermia on preservation of affected renal function (kidney with the tumor) compared to no hypothermia in patients who require hilar vessel clamping during open partial nephrectomy for a renal tumor.
Hypothesis: Hypothermia will result in improved post-operative preservation of affected renal function.
| Condition | Intervention |
|---|---|
|
Renal Impairment Kidney Diseases Urologic Diseases Cancer Hypothermia Kidney Cancer |
Procedure: Renal hypothermia |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Single Blind (Subject) Primary Purpose: Prevention |
| Official Title: | A Randomized Controlled Trial of Renal Hypothermia During Partial Nephrectomy |
- Renal function [ Time Frame: 12 months ] [ Designated as safety issue: No ]Glomerular filtration rate will be measured using the plasma clearance of 99mTc-DTPA.
- Difference in affected renal function [ Time Frame: 12 months ] [ Designated as safety issue: No ]Side-specific renal function will be calculated by the product of overall glomerular filtration (determined from 99mTc-DTPA plasma clearance) and relative renal contribution (determined from 99mTc-DMSA renal scintigraphy).
| Estimated Enrollment: | 180 |
| Study Start Date: | September 2012 |
| Estimated Study Completion Date: | September 2016 |
| Estimated Primary Completion Date: | March 2016 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
No Intervention: No hypothermia
After clamping of the renal vessels, no ice slush will be used.
|
|
|
Experimental: Hypothermia
After clamping of the renal vessels, the kidney will be surrounded in ice slush for 10 minutes.
|
Procedure: Renal hypothermia
Within 10 seconds of clamping the renal vessels, the kidney will be encased with saline ice slush for a period of 10 minutes. The slush will be created from sterile saline using an operating room slush machine. The slush is applied by the surgeon and lightly packed around the kidney to ensure complete coverage with at least a 2 cm layer. Slush removal is performed by the surgeon beginning at the 10 minute mark. Enough slush is removed to uncover the tumour area. Surgical incision of the kidney begins as soon as the tumour area is uncovered. When reconstruction of the kidney is complete, the slush is completely removed from the surgical field and the clamps are removed from the renal vein and artery. Other Name: Ice
|
Detailed Description:
The incidence of renal cell carcinoma is increasing and in 2008 it is estimated that over 51,000 new renal cancers will be diagnosed in the United States. To preserve renal function, urologists commonly remove the diseased segment of the kidney (partial nephrectomy) instead of removing the entire kidney (radical nephrectomy). While the benefit of preserving function in patients with renal cell carcinoma has become clear, optimal preservation techniques are yet to be determined. Specifically, the role of hypothermia during partial nephrectomy has been inadequately studied despite theoretical benefit. The investigators objective is to assess the effectiveness of renal hypothermia during partial nephrectomy. The investigators hypothesis is that renal hypothermia during partial nephrectomy results in improved post-operative renal function compared to warm ischemia.
Methods: To test the investigators hypothesis, 180 partial nephrectomy patients will be randomized to cold or warm ischemia. Global and side-specific renal function will be assessed pre-operatively and 12 months post-operatively using radionucleotide clearance and renal scintigraphy.
Significance: To the investigators knowledge, this study will be the first prospective trial to evaluate the clinical impact of renal hypothermia during partial nephrectomy. Since renal function preservation is the primary purpose of partial nephrectomy, these findings will have an important impact on surgical technique and patient outcome.
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Patients presenting with a renal mass deemed amenable to an open partial nephrectomy regardless of stage, histology, presence of solitary kidney, multiple tumors or renal function. Participating surgeons will identify patients they consider to be appropriate candidates for partial nephrectomy with or without renal hypothermia.
- Willing to consent to randomization
- Willing to comply with study protocol
Exclusion Criteria:
- Bilateral renal tumours with planned surgery either partial or radical nephrectomy on the contralateral kidney within the 12 months of the study.
- Life expectancy < 3 months as deemed by treating physician
- Age less than 18 years old
- Pregnancy
Contacts and Locations| Contact: Ilias Cagiannos, MD | 613-761-4500 ext 14500 | icagiannos@ottawahospital.on.ca |
| Contact: Louise LeBel, B.Sc.N. | 613-737-8899 ext 74639 | llebel@ohri.ca |
| United States, Minnesota | |
| The Mayo Clinic | Not yet recruiting |
| Rochester, Minnesota, United States, 55905 | |
| Principal Investigator: Bradley Leibovich, MD | |
| Canada, Ontario | |
| St. Joseph's Healthcare | Not yet recruiting |
| Hamilton, Ontario, Canada, L8N 4A6 | |
| Principal Investigator: Anil Kapoor, MD | |
| The Ottawa Hospital | Recruiting |
| Ottawa, Ontario, Canada, K1y 4E9 | |
| Principal Investigator: Ilias Cagianno, MD | |
| University Health Network | Not yet recruiting |
| Toronto, Ontario, Canada, M5G 2N2 | |
| Principal Investigator: Michael Jewett, MD | |
| Principal Investigator: | Ilias Cagiannos, MD | The Ottawa Hospital, Ottawa Hospital Research Institute |
More Information
No publications provided
| Responsible Party: | Ottawa Hospital Research Institute |
| ClinicalTrials.gov Identifier: | NCT01529658 History of Changes |
| Other Study ID Numbers: | 2010-767; CIHR MOP 269009 |
| Study First Received: | February 6, 2012 |
| Last Updated: | April 18, 2013 |
| Health Authority: | Canada: Ethics Review Committee United States: Institutional Review Board |
Keywords provided by Ottawa Hospital Research Institute:
|
Renal function Renal hypothermia Nephrology Nephrectomy |
Renal tumor Urology Kidney |
Additional relevant MeSH terms:
|
Carcinoma, Renal Cell Kidney Neoplasms Hypothermia Kidney Diseases Urologic Diseases Renal Insufficiency Adenocarcinoma Carcinoma |
Neoplasms, Glandular and Epithelial Neoplasms by Histologic Type Neoplasms Urologic Neoplasms Urogenital Neoplasms Neoplasms by Site Body Temperature Changes Signs and Symptoms |
ClinicalTrials.gov processed this record on May 23, 2013