Non-clamped partial nephrectomy: techniques and surgical outcomes.

Abstract

• To describe our technique of partial nephrectomy (PN) without vascular clamping with perioperative and short-term data to determine the safety, impact on renal function and oncological efficacy of this approach. • We performed a retrospective review of 952 PNs done at our institution between 1987 and 2009. Patients undergoing ex vivo PN with auto-transplantation, patients with Von Hippel-Lindau disease and patients with incomplete follow-up information were excluded from the analysis. • The four-variable modification of diet in renal disease equation was used to calculate estimated glomerular filtration rate (eGFR). • The percentage change in eGFR at 1 year was compared between the two groups. • The analysed cohort comprised 116 PNs done with renal vascular clamping (group A) and 192 PNs done without clamping (group B). The median tumour size was slightly larger in group B than in group A (3.0 vs 2.8 cm, P = 0.002). • There was no difference in preoperative eGFR (P = 0.304) or the prevalence of solitary kidney (P = 0.69). • Median estimated blood loss was 300 mL higher in the unclamped group (P < 0.001) and was associated with a higher rate of transfusion (P = 0.001). There was no difference the positive margin rate or rate of recurrence (P = 0.60). • The median percentage change in eGFR was a 12.3% decrease for group A and a 9.8% decrease for group B at 1 year (P= 0.037). In the subset of patients with solitary kidneys, the median change in eGFR was a 21% decrease in group A and a 4.4% decrease in group B at 1 year (P = 0.027). • The rate of complications was similar in groups A and B (11.2 vs 9.9%, P = 0.72). There were no perioperative deaths. • Partial nephrectomy can be safely performed without vascular clamping in appropriately selected patients. • Although PN without vascular clamping is associated with higher estimated blood loss, it is also associated with better preservation of renal function without compromising oncological efficacy, as evidenced by the solitary kidney cohort.