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Non-clamped partial nephrectomy: techniques and surgical outcomes.

Gjanjé L Smith1, Patrick A Kenney, Yoojin Lee

  • 1Institute of Urology, Lahey Clinic Medical Center, Burlington, MA, USA.

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Summary

Partial nephrectomy without vascular clamping offers better renal function preservation, especially in solitary kidney patients, without compromising oncological outcomes. This technique is safe for selected patients.

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Area of Science:

  • Urology
  • Nephrology
  • Surgical Oncology

Background:

  • Partial nephrectomy (PN) is a standard treatment for renal tumors.
  • Vascular clamping during PN can impair renal function.
  • The safety and efficacy of PN without vascular clamping require further evaluation.

Purpose of the Study:

  • To describe a technique of PN without vascular clamping.
  • To evaluate perioperative and short-term data on safety, renal function, and oncological outcomes.
  • To compare PN with and without vascular clamping.

Main Methods:

  • Retrospective review of 952 PNs (1987-2009).
  • Exclusion of ex vivo PN, Von Hippel-Lindau disease, and incomplete follow-up.
  • Calculation of estimated glomerular filtration rate (eGFR) using the MDRD equation.
  • Comparison of eGFR change at 1 year between clamped (Group A) and unclamped (Group B) groups.

Main Results:

  • 116 PNs (Group A) and 192 PNs (Group B) analyzed.
  • No significant difference in preoperative eGFR or solitary kidney prevalence.
  • Higher estimated blood loss and transfusion rates in Group B (P < 0.001, P = 0.001).
  • Similar positive margin and recurrence rates (P = 0.60).
  • Better eGFR preservation in Group B at 1 year (–9.8% vs. –12.3%, P = 0.037).
  • Significantly better eGFR preservation in solitary kidney patients in Group B (–4.4% vs. –21%, P = 0.027).
  • Similar complication rates (P = 0.72) and no perioperative deaths.

Conclusions:

  • PN can be safely performed without vascular clamping in selected patients.
  • Unclamped PN leads to better renal function preservation.
  • Oncological efficacy is maintained with the unclamped approach, particularly in solitary kidney cases.