Early Unclamping Laparoscopic Partial Nephrectomy for Complex Renal Tumor: Data from a Chinese Cohort

Zhang, Tao; Zhao, Li; Ma, Jiaxing; Min, Jie; Yang, Chao; Sun, Xin; Qian, Weiwei; Song, Jin Ho; Zhu, Jin-Bo; Yu, Dexin

doi:10.1159/000496990

Cited by 5 publications

(4 citation statements)

References 23 publications

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“…Tumor complexity, one of the important determinants of surgical and oncological outcomes, deeply impacts the decision of surgical approach . Several studies have demonstrated the safety and feasibility of minimally invasive PN for complex renal tumor, especially for complex T1a renal tumors . RPN has been considered as a feasible option in management of ≥4 cm renal tumors with moderate or high nephrometry scores as well .…”

Section: Discussionmentioning

confidence: 99%

Robot‐assisted versus laparoscopic partial nephrectomy for anatomically complex T1b renal tumors with a RENAL nephrometry score ≥7: A propensity score‐based analysis

Deng

Liu

et al. 2019

Cancer Medicine

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Objectives:To present the perioperative, functional, and oncological outcomes of robot-assisted partial nephrectomy (RPN) compared with laparoscopic partial nephrectomy (LPN) for anatomically complex T1b renal tumors with RENAL nephrometry scores ≥7. Patients and methods: One hundred and seventy patients, during the study period, were retrospectively reviewed in our analysis according to inclusion criteria.Propensity score matching (PSM) (1:1) method was applied to impose restrictions on the potential baseline confounders. The comparisons of perioperative and functional outcomes between the RPN and LPN groups were conducted and analyzed after PSM, Kaplan-Meier analyses were performed to assess the differences about oncological outcomes between the two groups before and after PSM. Results: One hundred and nine and 61 T1b renal tumors with RENAL scores ≥7 were identified in the LPN and RPN groups, respectively. All significant differences in baseline characteristics disappeared after PSM. Except for 3 patients missing an appropriate pair, all the patients in the RPN group were successfully matched to 58 patients in the LPN group in a 1:1 ratio. Within the matched cohort, the RPN group was related to a significantly shorter mean operating time (OT) (P = .040), shorter mean warm ischemia time (WIT) (P = .023), and shorter median postoperative hospital stay (P = .023). The possibilities of surgical conversion, postoperative complication, and positive surgical margin were similar in the LPN and RPN groups.And there was also no significant difference in the pathological, renal functional, and oncological outcomes between the two series. Conclusions: For patients with anatomically complex T1b renal tumors with a RENAL nephrometry score ≥7, RPN had an advantage over LPN in reducing OT, WIT, and postoperative hospital stay length without increasing the risk of | 587 DENG Et al.

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Section: Discussionmentioning

confidence: 99%

Robot‐assisted versus laparoscopic partial nephrectomy for anatomically complex T1b renal tumors with a RENAL nephrometry score ≥7: A propensity score‐based analysis

Deng

Liu

et al. 2019

Cancer Medicine

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“…Several centers in China and abroad have successively reported the clinical application of early unclamping technique. Zhang et al [13] reported 29 cases of laparoscopic partial nephrectomy with early unclamping. The results showed that the mean warm ischemia time was 13.4 min, signi cantly lower than 21.1 min in the control group.…”

Section: Discussionmentioning

confidence: 99%

Application and clinical efficacy of modified early unclamping technique in robot-assisted laparoscopic partial nephrectomy

Song

Chen

et al. 2022

Preprint

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Objective: To investigate the safety and clinical efficacy of modified early unclamping technique in robot-assisted laparoscopic partial nephrectomy (RAPN). Methods: The clinical data of 38 patients with renal tumor who underwent modified early unclamping technique in RAPN surgery admitted to the Department of Urology, the Third People's Hospital of Hangzhou and the First Affiliated Hospital of Nanchang University from January 2018 to April 2021 were retrospectively analyzed. The control group consisted of 78 patients with renal tumors who underwent standard clamping during the RAPN surgery completed by the same surgeon during the same period. The perioperative related indicators and postoperative renal function recovery were analyzed and compared between the two groups. Results: All patients (n = 116) finished the RAPN successfully, and none was transferred to radical and open surgery in both groups. The warm ischemia time in the modified early unclamping group was significantly lower than that in the standard clamping group (P < 0.001). After surgery, the renal function index at each time node in the modified early unclamping group were higher than those in the standard clamping group; renal function gradually returned to near preoperative levels after 3 months in both groups. Postoperative follow-up showed no tumor recurrence or metastasis. Conclusion: The application of modified early unclamping technique in RAPN surgery is safe and feasible. Compared with standard clamping, modified early unclamping can significantly shorten the warm ischemia time of kidneys, without increasing volume of intraoperative blood loss and complications, which helps to protect the postoperative renal function of patients.

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“…Several centers in China and abroad have successively reported the clinical application of the early unclamping technique. Zhang et al [ 18 ] reported 29 cases of laparoscopic partial nephrectomy with early unclamping. The results showed that the mean warm ischemia time was 13.4 min, which was significantly lower than 21.1 min in the control group.…”

Section: Discussionmentioning

confidence: 99%

Application and clinical efficacy of modified early unclamping technique in robot-assisted laparoscopic partial nephrectomy

Song

Chen

et al. 2022

BMC Urol

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Objective To investigate the clinical safety and efficacy of a modified early unclamping technique in robot-assisted laparoscopic partial nephrectomy (RAPN). Methods The clinical data of 38 patients with renal tumors who underwent the modified early unclamping technique in RAPN surgery admitted to the Department of Urology, the Third People's Hospital of Hangzhou and the First Affiliated Hospital of Nanchang University from January 2018 to April 2021 were retrospectively analyzed. The control group consisted of 78 patients with renal tumors who underwent standard clamping during the RAPN surgery completed by the same surgeon during the same period. The perioperative-related indicators and postoperative renal function recovery were analyzed and compared between the two groups. Results All patients (n = 116) finished the RAPN successfully, and none were transferred to radical or open surgery in either group. The warm ischemia time in the modified early unclamping group was significantly lower than that in the standard clamping group (P < 0.001). After surgery, the renal function index at each time point in the modified early unclamping group was higher than that in the standard clamping group; renal function gradually returned to near preoperative levels after 3 months in both groups. Postoperative follow-up showed no tumor recurrence or metastasis. Conclusion The application of a modified early unclamping technique in RAPN surgery is safe and feasible. Compared with standard clamping, modified early unclamping can significantly shorten the warm ischemia time of kidneys without increasing the volume of intraoperative blood loss and complications, which helps to protect the postoperative renal function of patients.

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Early Unclamping Laparoscopic Partial Nephrectomy for Complex Renal Tumor: Data from a Chinese Cohort

Cited by 5 publications

References 23 publications

Robot‐assisted versus laparoscopic partial nephrectomy for anatomically complex T1b renal tumors with a RENAL nephrometry score ≥7: A propensity score‐based analysis

Robot‐assisted versus laparoscopic partial nephrectomy for anatomically complex T1b renal tumors with a RENAL nephrometry score ≥7: A propensity score‐based analysis

Application and clinical efficacy of modified early unclamping technique in robot-assisted laparoscopic partial nephrectomy

Application and clinical efficacy of modified early unclamping technique in robot-assisted laparoscopic partial nephrectomy

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