Renal Hilar Control During Laparoscopic Partial Nephrectomy: To Clamp or Not to Clamp

Koo, Hyun Jung; Lee, Dong Hoon; Kim, Isaac Yi

doi:10.1089/end.2009.0123

Cited by 15 publications

(16 citation statements)

References 22 publications

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“…Among eligible studies, two were prospective cohort studies (level of evidence: 2b) [ 28 , 35 ], 19 were retrospective studies comparing contemporary series of patients (level of evidence: 3b) [ 9 , 15 , 16 , 18 – 21 , 23 , 25 , 27 , 29 – 34 , 36 – 38 ], and the remaining 4 studies used a historical series as controls (level of evidence: 4) [ 17 , 22 , 24 , 26 ]. A total of 14 studies containing a total number of ≤110 patients were considered as small-sample studies [ 9 , 15 – 20 , 23 , 28 , 29 , 34 – 36 , 38 ], whereas those containing over 110 patients in all were considered as large-sample studies [ 21 , 22 , 24 – 27 , 30 – 33 , 37 ].…”

Section: Resultsmentioning

confidence: 99%

Off-clamp partial nephrectomy has a positive impact on short- and long-term renal function: a systematic review and meta-analysis

Deng

Liu

et al. 2018

BMC Nephrol

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BackgroundOngoing efforts are focused on shortening ischemia intervals as much as possible during partial nephrectomy to preserve renal function. Off-clamp partial nephrectomy (off-PN) has been a common strategy for to avoid ischemia in small renal tumors. Although studies comparing the advantages between off-PN with conventional on-clamp partial nephrectomy (on-PN) have been reported, the impact on short- and especially long-term renal function of the two surgical methods has not been discussed seriously and remained unclear. Our purpose is to evaluate the impact on short- (within postoperative 3 months) and long-term (postoperative 6 months or longer) renal function of off-PN compared with that of on-PN.MethodsWe comprehensively searched databases, including PubMed, EMBASE, and the Cochrane Library, without restrictions on language or region. A systematic review and cumulative meta-analysis of the included studies were performed to assess the impact of the two techniques on short- and long-term renal function.ResultsA total of 23 retrospective studies and 2 prospective cohort studies were included. The pooled postoperative short-term decrease of estimated glomerular filtration rate (eGFR) was significantly less in the off-PN group (weighted mean difference [WMD]: 4.81 ml/min/1.73 m2; 95% confidence interval [CI]: 3.53 to 6.08; p < 0.00001). The short-term increase in creatinine (Cr) level in the on-PN group was also significant (WMD: − 0.05 mg/dl; 95%CI: − 0.09 to − 0.00; p = 0.04). Significant differences between groups was observed for the long-term change and percent (%) change of eGFR (p = 0.04 and p < 0.00001, respectively) but not for long-term Cr change (p = 0.40). The postoperative short-term eGFR and Cr levels, but not the postoperative long-term eGFR, differed significantly between the two groups. The pooled odds ratios for acute renal failure and postoperative progress to chronic kidney disease (stage≥3) in the off-PN group were found to be 0.25 (p = 0.003) and 0.73 (p = 0.34), respectively, compared with the on-PN group.ConclusionsOff-PN exerts a positive impact on the short- and long-term renal function compared with conventional on-PN. Given the inherent limitations of our included studies, large-volume and well-designed RCTS with extensive follow up are needed to confirm and update the conclusion of this analysis.Electronic supplementary materialThe online version of this article (10.1186/s12882-018-0993-3) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Off-clamp partial nephrectomy has a positive impact on short- and long-term renal function: a systematic review and meta-analysis

Deng

Liu

et al. 2018

BMC Nephrol

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“…In fact, there was a significant difference in ischemic time between the RAPN cohort and the OPN cohort after propensity matching ( Table 2 ). To fully address this issue, several studies have reported that irreversible renal damage to the healthy contralateral kidney may be avoided by limiting ischemia time to less than 30 or 40 minutes ( 32 33 34 ), and 16.7% of patients who underwent RAPN had ischemia times longer than 30 minutes. Other studies have also argued that ischemia time has less of an effect on renal function over the long-term, although this opinion is controversial ( 29 30 35 ).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Renal Function between Robot-Assisted and Open Partial Nephrectomy as Determined by Tc 99m-DTPA Renal Scintigraphy

et al. 2016

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We compared postoperative renal function impairment between patients undergoing robot-assisted partial nephrectomy (RAPN) and those undergoing open partial nephrectomy (OPN) by using Tc-99m diethylenetriaminepentaacetic acid (DTPA) renal scintigraphy. Patients who underwent partial nephrectomy by a single surgeon between 2007 and 2013 were eligible and were matched by propensity score, based on age, tumor size, exophytic properties of tumor, and location relative to the polar lines. Of the 403 patients who underwent partial nephrectomy, 114 (28%) underwent RAPN and 289 (72%) underwent OPN. Mean follow-up duration was 35.2 months. Following propensity matching, there were no significant differences between the two groups in tumor exophytic properties (P = 0.818) or nephrometry score (P = 0.527). Renal ischemic time (24.4 minutes vs. 17.8 minutes, P < 0.001) was significantly longer in the RAPN group than in the OPN group, while the other characteristics were similar. Multivariate analysis showed that greater preoperative renal unit function (P = 0.011) and nephrometry score (P = 0.041) were independently correlated with a reduction in glomerular filtration rate. The operative method did not correlate with renal function impairment (P = 0.704). Postoperative renal function impairment was similar between patients who underwent OPN and those who underwent RAPN, despite RAPN having a longer ischemic time.

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“…Although occlusion of the main renal artery with a vessel loop and kidney incision using a primary no-clamp technique or highly selective clamping of the renal artery in the kidney has been reported, it is more applicable to small exophytic renal masses, not endophytic or hilar tumors. Indeed, renal hilar control is deemed necessary to decrease blood loss and provide better oncologic control if the depth of tumor invasion is >50% of the renal parenchyma on CT or MRI [9]. After successfully handling the dangerous hilum, the choice of the exact incision line is crucial to achieve favorable outcomes.…”

Section: Discussionmentioning

confidence: 99%

Retroperitoneal Laparoscopic Partial Nephrectomy for Moderately Complex Renal Hilar Tumors

Zhang²,

Jin³

2013

Urol Int

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Objectives: To report our initial experience in retroperitoneal laparoscopic partial nephrectomy (LPN) for moderately complex renal hilar tumors and summarize the feasibility of the retroperitoneal laparoscopic approach. Materials and Methods: 14 patients with renal hilar tumors underwent retroperitoneal LPN between June 2010 and January 2012 at our institution. All of the masses were confirmed in the hilar location by computed tomography preoperatively and then evaluated with the R.E.N.A.L. nephrometry scoring system; all were defined as moderately complex lesions. A three-port retroperitoneal approach with a dorsal incision was used in all cases. Patient baseline demographics, perioperative outcomes and pathological characteristics were recorded based on a retrospective data collection and telephone interview. Results: All operations were performed successfully without conversion to radical nephrectomy or open surgery. Only two complications of perirenal fluid collection occurred, but the patients recovered with active surveillance. Mean operative time was 134.3 min, mean estimated blood loss 133.2 ml, mean warm ischemia time 30.6 min and mean retroperitoneal drainage 2.2 days. Mean postoperative hospital stay was 4.7 days. No recurrence or metastasis occurred in these patients at a mean follow-up of 18.6 months. Conclusions: Our initial experience suggests that retroperitoneal LPN is a feasible, safe and effective procedure for moderately complex renal hilar tumors. Although it remains technically challenging, this approach can be recommended in some complex cases when in experienced hands.

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Renal Hilar Control During Laparoscopic Partial Nephrectomy: To Clamp or Not to Clamp

Cited by 15 publications

References 22 publications

Off-clamp partial nephrectomy has a positive impact on short- and long-term renal function: a systematic review and meta-analysis

Off-clamp partial nephrectomy has a positive impact on short- and long-term renal function: a systematic review and meta-analysis

Comparison of Renal Function between Robot-Assisted and Open Partial Nephrectomy as Determined by Tc 99m-DTPA Renal Scintigraphy

Retroperitoneal Laparoscopic Partial Nephrectomy for Moderately Complex Renal Hilar Tumors

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