You have accessJournal of UrologyKidney Cancer: Localized1 Apr 20111529 OFF-CLAMP PARTIAL NEPHRECTOMY PRESERVES LONG-TERM RENAL FUNCTION Arvin George, Amin Herati, Soroush Rais-Bahrami, Nikhil Waingankar, Jeffery Ma, Eric Ghraldi, Lee Richstone, and Louis Kavoussi Arvin GeorgeArvin George Mineola, NY More articles by this author , Amin HeratiAmin Herati New Hyde Park, NY More articles by this author , Soroush Rais-BahramiSoroush Rais-Bahrami New Hyde Park, NY More articles by this author , Nikhil WaingankarNikhil Waingankar New Hyde Park, NY More articles by this author , Jeffery MaJeffery Ma New Hyde Park, NY More articles by this author , Eric GhraldiEric Ghraldi New Hyde Park, United States Minor Outlying Islands More articles by this author , Lee RichstoneLee Richstone New Hyde Park, NY More articles by this author , and Louis KavoussiLouis Kavoussi New Hyde Park, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1522AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoscopic partial nephrectomy (LPN) is traditionally completed with vascular control of the renal hilum. Hilar clamping may lead to irreversible loss of renal function due to warm ischemia and ischemia-reperfusion injury. This study assesses immediate and 6-month renal functional outcomes in patients undergoing LPN with and without renal hilar clamping. METHODS A prospective review was completed of 435 patients undergoing LPN. Patient demographics, peri-operative parameters, and post-operative outcomes were recorded. Estimated GFR (eGFR) was calculated using the Cockroft-Gault formula. Logistic regression analysis was performed compareing characteristics of each group, stratified by clamp status. RESULTS Two hundred and eighty five patients underwent on-clamp LPN and 150 were performed off-clamp. There were no significant differences among pre-operative patient characteristics amongst the groups. Mean tumor size was 3.3cm (0.5–13.5cm) for on-clamp lesions and 2.7cm(0.4–9cm) for off-clamp lesions (p=0.0036). Mean estimated blood loss was greater in the off-clamp group (p=0.0230) though this difference was not clinically significant. Immediate and 6-month change in post-operative creatinine and % change in creatinine were significantly lower among off-clamp patients (Table 1). Mean change in 6-month eGFR was 66% less in the off-clamp cohort which approached statistical significance (p=0.0605). There was no difference in positive margin status nor complication rates between the groups. Table 1. Patient and peri-operative characteristics Clamp (n=285) Off-Clamp (n= 150) P-Value Male 182 (64⁎) 98 (65) NS (gender) Female 103 (36) 52 (35) — Age (years) 59.2 (21–84⁎) 59.4 (26–81) NS BMI (kg/m2) 29.6 (15–62.3) 29.8 (16–70) NS Estimated Blood Loss (ml) 276.8 (0–1300) 338.4 (0–1700) 0.0230 Operating Time (mins) 141.4 (31–400) 137.1 (35–441) NS ASA 2.3 (1–4) 2.3 (1–4) NS % Change Creatinine (post-op) 26.9 (-28.9–134.3) 8.96 (-25–117.8) % Change Creatinine (6-month) 17.3 (-36.4–100.9) 8.7 (-55.6–66.7) 0.0197 Change in eGFR (postop) 16.9 (-1035–96.6) 4.2 (-87.6–76,6) Change in eGFR (6-month) 11.7 (-83.2–74.2) 3.9 (-181.6–80.2) 0.0605 (⁎) = Data represents percentages for categorical variables and range for continuous variables. CONCLUSIONS Off-clamp partial nephrectomy completely avoids warm ischemia and better preserves renal function at 6-month follow-up. With experience off-clamp LPN may be applied to more complex renal lesions. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e614 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Arvin George Mineola, NY More articles by this author Amin Herati New Hyde Park, NY More articles by this author Soroush Rais-Bahrami New Hyde Park, NY More articles by this author Nikhil Waingankar New Hyde Park, NY More articles by this author Jeffery Ma New Hyde Park, NY More articles by this author Eric Ghraldi New Hyde Park, United States Minor Outlying Islands More articles by this author Lee Richstone New Hyde Park, NY More articles by this author Louis Kavoussi New Hyde Park, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...