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Published on: July 19, 2011
Selective Artery Clamping Superior to Main Artery Clamping in Preserving Ipsilateral Renal Function after Minimally
Xiangpeng Zou1,2, Xiaofeng Yang1,2, Yunhan Luo1,2
1Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
Background:
The renal functional advantages of selective artery clamping (SAC) compared with main artery clamping (MAC) remain inconsistent. This study aimed to assess the impact of SAC versus MAC on ipsilateral renal function after minimally invasive partial nephrectomy (MIS-PN) in patients with bilateral kidneys.
Patients And Methods:
This study included 692 patients with bilateral kidneys who underwent ipsilateral clamped MIS-PN using either SAC or MAC, with available imaging, serum creatinine, and split renal function measured at defined pre- and postoperative time points. Propensity score matching (PSM, 1:2) was performed to balance baseline characteristics. Spectrum score was used to assess the degree of acute ipsilateral renal dysfunction. Recovery from ischemia (Recischemia) was defined as ipsilateral glomerular filtration rate preserved% normalized by parenchymal volume preserved%. Multivariable linear regression analyses were conducted to identify factors associated with Recischemia and spectrum score.
Results:
After PSM, 365 patients were analyzed (125 SAC/240 MAC). In the limited ischemia cohort (warm ischemia time [WIT] ≤ 30 min) (94 SAC/177 MAC), no significant differences were observed between the SAC and MAC groups in the spectrum score (0.1 vs. 0.1, p = 0.66) or Recischemia (92.9% vs. 94.2%, p = 0.97). However, in the prolonged ischemia cohort (WIT >30 min) (31 SAC/63 MAC), the SAC group exhibited significantly better Recischemia (97.9% vs. 92.5%, p = 0.03) and a lower spectrum score (0.1 vs. 0.2, p = 0.02) than the MAC group. Multivariable analyses confirmed SAC as an independent predictor of improved Recischemia (p < 0.01) and alleviated acute ipsilateral renal dysfunction (p = 0.03) in the prolonged ischemia cohort. Compared with the MAC group, the SAC group had a longer operative time (169 vs. 128 min, p < 0.01) and greater blood loss (100 vs. 50 mL, p < 0.01).
Conclusions:
Under prolonged WIT, SAC afforded superior ipsilateral renal function preservation compared with MAC in patients with bilateral kidneys, which guides experienced surgeons in optimizing MIS-PN strategies for patients with complex renal masses.
