Impact of Left Renal Vein Ligation on Renal Function Following En Bloc Resection of Segmental Inferior Vena Cava and Right Kidney.

BACKGROUND: Renal function after left renal vein (LRV) ligation following en bloc resection of segmental inferior vena cava (IVC) and right kidney is understudied. We assessed the impact of LRV ligation on postoperative renal function following en bloc resection of segmental IVC and right kidney. METHODS: We retrospectively reviewed 28 patients who underwent LRV ligation during en bloc resection of segmental IVC and right kidney. Patient demographics, tumor characteristics, intraoperative factors, complications, length of hospital and intensive care unit (ICU) stay, and patient survival were collected. Pre- and postoperative renal function was retrospectively analyzed. RESULTS: Twenty patients underwent robot-assisted surgery and eight patients underwent open surgery. The median operative time was 162 min and estimated blood loss was 350 mL. Ten patients had normal renal function and 12 patients had an initial increase in creatinine but improved gradually. Six patients developed acute renal failure; five patients gradually recovered in 5-32 days after temporary hemodialysis. Renal replacement therapy significantly correlated with maximal anterior-posterior diameter of the LRV (p = 0.001). Complications were observed in 11 cases, four of which were Clavien-Dindo grades I-II. Thirteen patients were alive with no recurrence, nine patients were alive with metastasis, and six cases died during the follow-up period. CONCLUSIONS: LRV ligation following en bloc resection of segmental IVC and right kidney is feasible, with no significant long-term impact on renal function. The maximum anterior-posterior diameter of the LRV is a reliable method for predicting renal replacement therapy in the absence of collateral circulation.

Interaction effect of polycyclic aromatic hydrocarbon metabolites and cadmium on semen quality in nonsmokers.

Both cadmium (Cd) and polycyclic aromatic hydrocarbons (PAHs) are known reproductive toxicants, but their co-exposure and interaction effect on semen quality particularly in nonsmokers remain unknown. We included 333 nonsmoking men and analyzed their urine and semen samples for heavy metals and PAH metabolites. Restricted cubic spline models were used to explore the dose-response relationship between each OH-PAHs, Cd, and semen quality parameters; the generalized linear model was performed to examine the interaction of each urinary OH-PAH metabolite and Cd concentration on semen quality. Also, stratified analysis was applied to further illustrate the independent effect of PAHs on semen quality parameters in low and high concentration Cd subgroups. The dose-response and interaction effect of PAHs and Cd on male semen quality was observed. Stratified analysis in the high concentration Cd subgroup showed a negative association of 1-OHPyr concentration with semen motility. Our findings indicate that Cd not only modifies the association between PAHs and semen quality but can also exacerbate the toxic effect of pyrene on semen quality parameters. However, further studies with larger samples are needed to confirm the findings.