To evaluate the effect of artery-only (AO) and artery–vein (AV) clamping during partial nephrectomy (PN) on short- and long-term renal function outcome.
Medical records of 154 patients in the AO group and 192 patients in the AV group who underwent open and minimally invasive (laparoscopic/robotic) PN between January 2011 and January 2018 were retrospectively assessed. Preoperative patient and tumor-specific characteristics in addition to perioperative factors and renal function outcomes were compared. The change in the estimated glomerular filtration rate (eGFR) from postoperative 1–3 days, 12 and 24 months after surgery was calculated. Acute kidney injury (AKI) was defined a as a > 25% reduction in eGFR.
There were no statistically significant differences between the clamping techniques in terms of postoperative 1–3 days, 12 and 24 months eGFR change percentage and risk of progression to chronic kidney disease (CKD). No significant difference in short- and long-term renal functions was found between the minimally invasive or open AO and AV clamping subgroups at any time point. In multivariate analysis, the R.E.N.A.L score (AO group p = 0.026, AV group p < 0.001) and preoperative eGFR (AO group p < 0.001, AV group p = 0.010) were strong predictors of the acute kidney injury in both groups. Older age (AO group p = 0.045, AV group p = 0.010) and preoperative eGFR (AO group p = 0.008, AV group p = 0.002) were significantly associated with CKD progression at 2-year follow-up in both groups.
AV clamping does not adversely affect postoperative renal function compared to AO clamping. Preoperative patient- and tumor-related factors are more important for renal function regardless of the clamping technique.
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The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (approval number; I5-289-20) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
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Akpinar, C., Suer, E., Baklaci, U. et al. The effect of renal artery-only or renal artery–vein clamping during partial nephrectomy on short and long-term functional results: Is clamping technique important?. Int Urol Nephrol (2021). https://doi.org/10.1007/s11255-021-02812-y
- Artery-only clamping
- Artery–vein clamping
- Partial nephrectomy
- Renal function