Kosin Med J.  2018 Dec;33(2):191-199. 10.7180/kmj.2018.33.2.191.

Comparative study of off-clamp, laparoscopic partial nephrectomy (OCLPN) and conventional hilar control, laparoscopic partial nephrectomy (HCLPN) for renal tumors: One-year follow-up results of renal function change

• Kang SH
• Rhew HY
• Kim TS

• KMID: 2430734
• DOI: http://doi.org/10.7180/kmj.2018.33.2.191

Abstract

OBJECTIVES
We designed the study to compare the oncologic and renal function outcomes of off-clamp, laparoscopic partial nephrectomy (OCLPN) and conventional laparoscopic partial nephrectomy (HCLPN) for renal tumors.
METHODS
Between March 2008 and July 2015, 114 patients who underwent laparoscopic partial nephrectomy (LPN) of a renal neoplasm were studied. We performed LPN without hilar clamp on 40 patients (OCLPN, Group 1), and conventional LPN with hilar control and renorrhaphy on another 40 patients (HCLPN, Group 2). We retrospectively reviewed the medical records of each patient's age, sex, R.E.N.A.L. nephrometry score (RNS), operation time, complications, hospitalization period, tumor size, positive resection margin, histologic classification of tumor, pathologic stage, Fuhrman grade, estimated blood loss (EBL), warm ischemic time (WIT), and estimated glomerular filtration rate (eGFR) before and one year after surgery.
RESULTS
There were no significant differences in age, sex, preoperative eGFR, EBL, surgical (anesthesia) time, and tumor size between the two groups. The mean eGFR was not significantly different between the OCLPN and HCLPN groups 1 month (95 and 86.2 mL/min/1.73 m², respectively; P = 0.106), 6 months (92.9 and 83.6 mL/min/1.73 m², respectively; P = 0.151) and 12 months (93.8 and 84.7 mL/min/1.73 m², respectively; P = 0.077) postoperatively. The change in eGFR after one year was 3.9% in the OCLPN group and −7.9% in the HCLPN group.
CONCLUSIONS
OCLPN was superior to HCLPN in preserving renal function one year after surgery, and there was no statistically significant difference in tumor treatment results.

Keyword

Kidney neoplasm; Laparoscopic partial nephrectomy; Off-clamp

MeSH Terms

Classification
Follow-Up Studies*
Glomerular Filtration Rate
Hospitalization
Humans
Kidney Neoplasms
Medical Records
Nephrectomy*
Retrospective Studies
Warm Ischemia

Figure

• 

  Fig. 1 Procedure of OCLPN (A) Self-made Rummel tourniquets or bulldog clamps were hung on the renal hilar vessels for quick vessel clamping. (B) Linear cauterization marking made by monopolar hook electrode. (C) Marked margin around renal mass was excised using 10-mm Metzenbaum scissors with minimal safety margins. (D) Biologic hemostatics such as Floseal and Tissel were used in the excised renal bed. (E) Parenchymal defect was filled with Surgicel and Gelfoam (F) Renal parenchyma, perirenal fat and Gerota's fascia were approximated using V-loc and 3–0 Vicryl

• 

  Fig. 2 Comparison of renal function (eGFR, mL/min/1.73 m2) between the OCLPN and HCLPN groups preoperatively and in the 12 months following surgery.

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