Abstract
Background and Objective:Open partial nephrectomy (PN) is still considered gold standard procedure for T1 localized renal tumors. Conventional technique involves clamping of the renal artery with or without vein however, renal ischemia produces a certain level of damage to the kidneys. This study aims to investigate potential effect of off-clamp vs. hilar clamping PN on renal function.Methods:This is a retrospective cohort study of patients who underwent unilateral, open partial nephrectomy for renal tumors b/w January 2009 December 2016 at our institution. A total of 90 partial nephrectomies were performed of which 65 cases were eligible for analysis. Non clamping technique was used in 43 while clamp was applied in 22 patients. Variables studied were patients’ demographics, clinical variables, the laterality, tumors size and location, R.E.N.A.L nephrometry score, blood loss, tumor histology and surgical margins. Patients’ renal function (serum creatinine and eGFR) were determined pre-operatively, at 3 and 12 months follow up. Data was analyzed on SPSS v. 22.Results:Both the groups were comparable with regards to pre-operative renal function. Mean radiological size of tumor was 4.71±1.31 and 3.81±1.0 (0.003) in two groups respectively. Mean R.E.N.A.L nephrometry score was 6.1±1.5 in off-clamp group compared to 7.05 ± 1.7 in clamp group (p=0.04). No statistically significant difference was found in operative duration, blood loss, positive surgical margins and intra/ peri-operative complications. At three months and one year, renal function was better preserved in non-clamp group compared to clamp group (p=0.001 and 0.007 respectively).Conclusion:Off clamp open partial nephrectomy is safe and feasible option leading to less decline in renal function.
Highlights
Nephron sparing surgery is traditionally used in patients with tumor in anatomically or functionally solitary kidney, bilateral synchronous tumors or in the presence of medical co-morbid condition(s) affecting the renal function.[1]
Open partial nephrectomy (PN) is regarded as ‘standard of care’ procedure for T1 localized renal tumors2 & has shown to produce similar oncological but superior functional outcome compared to radical nephrectomy.[3,4,5]
The variables studied included patients’ demographics such as age, gender, weight, height, body mass index (BMI), co-morbid medical condition(s) such as diabetes mellitus (DM) and hypertension (HTN), American society of anesthesiologist (ASA) score, tumor characteristics like tumor size and location, laterality, R.E.N.A.L nephrometry score 8 {comprising of Radius, Exophytic or endophytic nature, Nearness of tumor to collecting system, Anterior or posterior and Location relative to polar lines}, intra-operative data such as overall operative time, warm ischemia time, estimated blood loss and transfusion rate, postoperative outcomes such as length of hospital stay, tumor histology, surgical margins, Fuhrman’s nuclear grade and 30-days post-operative complications measured by modified Claviandindo classification
Summary
Nephron sparing surgery is traditionally used in patients with tumor in anatomically or functionally solitary kidney, bilateral synchronous tumors or in the presence of medical co-morbid condition(s) affecting the renal function.[1] Open partial nephrectomy (PN) is regarded as ‘standard of care’ procedure for T1 localized renal tumors2 & has shown to produce similar oncological but superior functional outcome compared to radical nephrectomy.[3,4,5] Performing complete tumor excision and achieving adequate hemostasis makes partial nephrectomy a challenging procedure.[6] Conventional technique for PN involves clamping. Methods: This is a retrospective cohort study of patients who underwent unilateral, open partial nephrectomy for renal tumors b/w January 2009 December 2016 at our institution.
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