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Off-clamp versus complete hilar control laparoscopic partial nephrectomy: comparison by clinical stage
Soroush Rais-Bahrami1, Arvin K George, Amin S Herati
1Arthur Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, NY 11040, USA.
BJU International
|October 14, 2011
Summary
Off-clamp laparoscopic partial nephrectomy (LPN) is a feasible technique for renal tumors, avoiding ischemic injury without compromising outcomes. This approach offers the benefits of minimally invasive surgery for various tumor stages.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Renal Oncology
Background:
- Minimizing renal ischemia and reperfusion injury is crucial in laparoscopic renal surgery.
- Off-clamp techniques may offer renal function protection during partial nephrectomy.
Purpose of the Study:
- To compare operative outcomes and oncological efficacy of off-clamp (OC) versus complete hilar control (HC) laparoscopic partial nephrectomy (LPN).
- To evaluate OC LPN for T1a-T2 renal cell carcinoma.
Main Methods:
- Retrospective review of 390 LPN cases (June 2006-March 2010).
- Patients stratified by clinical T stage (cT1a, cT1b, cT2).
- Comparison of perioperative and postoperative parameters between OC LPN (n=126) and HC LPN (n=264).
Main Results:
- No significant difference in OC LPN proportion across tumor stages.
- OC LPN had greater estimated blood loss (EBL) in cT1a, but no significant difference in transfusion rates.
- No difference in operative time or hospitalization length between OC and HC LPN across stages.
Conclusions:
- Off-clamp LPN is a feasible option for cT1-T2 renal cell carcinoma, avoiding ischemic injury.
- OC LPN can be performed on larger, complex tumors without compromising key surgical outcomes compared to HC LPN.
