Comparison of clamping strategies in minimally invasive partial nephrectomy for cT1 tumors.

OBJECTIVES: To determine whether artery only (AO) clamping promises any advantage over artery and vein (AV) clamping in patients undergoing partial nephrectomy with minimally invasive surgical techniques. MATERIAL AND METHODS: We retrospectively analyzed the data of 68 partial nephrectomy patients who were treated with minimally invasive techniques (robot-assisted laparoscopic or pure laparoscopic) for solitary, unilateral, cT1 renal masses during the period of 2008-2019 in a single institution. Patients were divided into two groups according to clamping strategy (AO and AV). The two groups were compared to each other in terms of perioperative outcomes and long-term functional results. RESULTS: The mean patient age and median follow-up period were 56.8 ± 10.8 years and 13.5 (9-44.5) months, respectively. Warm ischemia time, estimated blood loss, transfusion rate and length of hospital stay were similar between the two groups, while operative time was significantly higher in the AO clamping group (p = .726, p = .604, p = .675, p = .103, and p = .038, respectively). Patients who underwent AV clamping had a significantly lower estimated glomerular filtration rate (eGFR) and higher chronic kidney disease rates six months postoperatively (p = .001 and p = .044, respectively) and at the last follow-up (p = .020 and p = .048, respectively). The percentage of eGFR change at six months and the last follow-up was higher in the AV clamp group but the difference was not statistically significant (p = .056 and p = .082, respectively). CONCLUSIONS: Our findings suggest AO clamping is safe and comparable to AV clamping. In our study, AO clamping was found to be superior to AV in terms of long-term eGFR preservation.

Comparison of Renal Artery vs Renal Artery-Vein Clamping During Partial Nephrectomy: A System Review and Meta-Analysis.

Background: Although artery-only (AO) clamping has been proposed to minimize ischemic renal damage compared with artery-vein (AV) clamping, the benefit of AO clamping during laparoscopic partial nephrectomy (LPN) is still controversial. We performed a systematic review and meta-analysis to test the difference between AO clamping and AV clamping in partial nephrectomy (PN). Materials and Methods: A systematic review of the literature on PubMed, Web of Science, the Cochrane Library, and Embase was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement to search-related studies. Data were extracted using a reporting checklist proposed by the Meta-analysis of Observational Studies in Epidemiology Group. RevMan 5.3 software and Stata 12.0 were used to do meta-analysis. Results: The present meta-analysis included 2 retrospective and 3 prospective studies, including 242 patients who underwent AO clamping and 369 patients who underwent AV clamping, which compared AO and AV clamping in LPN for renal cell carcinoma. At baseline, no statistically significant differences were detected between AO and AV clamping groups in terms of body mass index (p = 0.23), tumor size (p = 0.95), but AO clamping group had significantly lower RENAL Score (fixed effects [FE]: weighted mean difference [WMD]: 0.36, p = 0.007). For surgical outcomes analysis, no significant difference was detected regarding to warm ischemia (p = 0.58), operating time (p = 0.40), transfusion rate (p = 0.58), and estimated blood loss (p = 0.35) between two groups. The assessment of renal function by creatinine value both at the early postoperative (p = 0.36) and at last follow-up (p = 0.38) revealed no difference. There was no significant difference in estimated glomerular filtration rate (eGFR) (p = 0.62), and at the early postoperative percentage decrease of eGFR (p = 0.79). However, a higher percentage decrease of eGFR decrease at last follow-up was demonstrated for the AV clamping group (FE: WMD: 2.42, p < 0.00001). Conclusion: These results suggest that AO clamping might be a better choice for PN in long term. Randomized controlled trial studies with larger sample numbers and long-term follow-up and split renal function assessment should be conducted in the future to confirm our conclusion.