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?

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. 1.

    Campbell SC, Novick AC, Belldegrun A, Blute ML, Chow GK, Derweesh IH, Faraday MM, Kaouk JH, Leveillee RJ, Matin SF, Russo P, Uzzo RG (2009) Guideline for management of the clinical T1 renal mass. J Urol 182(4):1271–1279. https://doi.org/10.1016/j.juro.2009.07.004

    Article  PubMed  Google Scholar 

  2. 2.

    Ljungberg B, Bensalah K, Canfield S, Dabestani S, Hofmann F, Hora M, Kuczyk MA, Lam T, Marconi L, Merseburger AS, Mulders P, Powles T, Staehler M, Volpe A, Bex A (2015) EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 67(5):913–924. https://doi.org/10.1016/j.eururo.2015.01.005

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Zini L, Perrotte P, Capitanio U, Jeldres C, Shariat SF, Antebi E, Saad F, Patard JJ, Montorsi F, Karakiewicz PI (2009) Radical versus partial nephrectomy: effect on overall and noncancer mortality. Cancer 115(7):1465–1471. https://doi.org/10.1002/cncr.24035

    Article  PubMed  Google Scholar 

  4. 4.

    Haber GP, Gill IS (2006) Laparoscopic partial nephrectomy: contemporary technique and outcomes. Eur Urol 49(4):660–665. https://doi.org/10.1016/j.eururo.2006.02.001

    Article  PubMed  Google Scholar 

  5. 5.

    Mir MC, Ercole C, Takagi T, Zhang Z, Velet L, Remer EM, Demirjian S, Campbell SC (2015) Decline in renal function after partial nephrectomy: etiology and prevention. J Urol 193(6):1889–1898. https://doi.org/10.1016/j.juro.2015.01.093

    Article  PubMed  Google Scholar 

  6. 6.

    Blum KA, Paulucci DJ, Abaza R, Eun DD, Bhandari A, Delto JC, Krane LS, Hemal AK, Badani KK (2016) Main renal artery clamping with or without renal vein clamping during robotic partial nephrectomy for clinical T1 renal masses: perioperative and long-term functional outcomes. Urology 97:118–123. https://doi.org/10.1016/j.urology.2016.08.028

    Article  PubMed  Google Scholar 

  7. 7.

    Funahashi Y, Kato M, Yoshino Y, Fujita T, Sassa N, Gotoh M (2014) Comparison of renal ischemic damage during laparoscopic partial nephrectomy with artery-vein and artery-only clamping. J Endourol 28(3):306–311. https://doi.org/10.1089/end.2013.0446

    Article  PubMed  Google Scholar 

  8. 8.

    Gong EM, Zorn KC, Orvieto MA, Lucioni A, Msezane LP, Shalhav AL (2008) Artery-only occlusion may provide superior renal preservation during laparoscopic partial nephrectomy. Urology 72(4):843–846. https://doi.org/10.1016/j.urology.2008.05.020

    Article  PubMed  Google Scholar 

  9. 9.

    Orvieto MA, Zorn KC, Mendiola F, Lyon MB, Mikhail AA, Gofrit ON, Shalhav AL (2007) Recovery of renal function after complete renal hilar versus artery alone clamping during open and laparoscopic surgery. J Urol 177(6):2371–2374. https://doi.org/10.1016/j.juro.2007.01.115

    Article  PubMed  Google Scholar 

  10. 10.

    Tracy CR, Terrell JD, Francis RP, Wehner EF, Smith J, Litorja M, Hawkins DL, Pearle MS, Cadeddu JA, Zuzak KJ (2010) Characterization of renal ischemia using DLP hyperspectral imaging: a pilot study comparing artery-only occlusion versus artery and vein occlusion. J Endourol 24(3):321–325. https://doi.org/10.1089/end.2009.0184

    Article  PubMed  Google Scholar 

  11. 11.

    Berger A, Crouzet S, Canes D, Haber GP, Gill IS (2008) Minimally invasive nephron-sparing surgery. Curr Opin Urol 18(5):462–466. https://doi.org/10.1097/MOU.0b013e32830a4f10

    Article  PubMed  Google Scholar 

  12. 12.

    Kutikov A, Uzzo RG (2009) The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182(3):844–853. https://doi.org/10.1016/j.juro.2009.05.035

    Article  Google Scholar 

  13. 13.

    Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A (2007) Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 11(2):R31. https://doi.org/10.1186/cc5713

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Earley A, Miskulin D, Lamb EJ, Levey AS, Uhlig K (2012) Estimating equations for glomerular filtration rate in the era of creatinine standardization: a systematic review. Ann Intern Med 156 (11):785–795, w-270, w-271, w-272, w-273, w-274, w-275, w-276, w-277, w-278. https://doi.org/10.7326/0003-4819-156-6-201203200-00391

  15. 15.

    Schrier RW, Wang W, Poole B, Mitra A (2004) Acute renal failure: definitions, diagnosis, pathogenesis, and therapy. J Clin Invest 114(1):5–14. https://doi.org/10.1172/jci22353

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Colli JL, Wang Z, Johnsen N, Grossman L, Lee BR (2013) Clamping renal artery alone produces less ischemic damage compared to clamping renal artery and vein together in two animal models: near-infrared tissue oximetry and quantitation of 8-isoprostane levels. Int Urol Nephrol 45(2):421–428. https://doi.org/10.1007/s11255-012-0297-7

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Imbeault A, Pouliot F, Finley DS, Shuch B, Dujardin T (2012) Prospective study comparing two techniques of renal clamping in laparoscopic partial nephrectomy: impact on perioperative parameters. J Endourol 26(5):509–514. https://doi.org/10.1089/end.2011.0088

    Article  PubMed  Google Scholar 

  18. 18.

    Liu ZW, Faddegon S, Olweny EO, Best SL, Jackson N, Raj GV, Zuzak KJ, Cadeddu JA (2013) Renal oxygenation during partial nephrectomy: a comparison between artery-only occlusion versus artery and vein occlusion. J Endourol 27(4):470–474. https://doi.org/10.1089/end.2012.0466

    Article  PubMed  Google Scholar 

  19. 19.

    Lane BR, Campbell SC, Demirjian S, Fergany AF (2013) Surgically induced chronic kidney disease may be associated with a lower risk of progression and mortality than medical chronic kidney disease. J Urol 189(5):1649–1655. https://doi.org/10.1016/j.juro.2012.11.121

    Article  PubMed  Google Scholar 

  20. 20.

    Cao J, Zhu S, Ye M, Liu K, Liu Z, Han W, Xie Y (2020) Comparison of renal artery vs renal artery-vein clamping during partial nephrectomy: a system review and meta-analysis. J Endourol 34(4):523–530. https://doi.org/10.1089/end.2019.0580

    Article  PubMed  Google Scholar 

  21. 21.

    Andreucci M, Faga T, Pisani A, Perticone M, Michael A (2017) The ischemic/nephrotoxic acute kidney injury and the use of renal biomarkers in clinical practice. Eur J Intern Med 39:1–8. https://doi.org/10.1016/j.ejim.2016.12.001

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Bang JK, Song C, Hong B, Park H, Kim C-S, Ahn H (2007) The effectiveness of simultaneous renal artery-vein clamping during laparoscopic partial nephrectomy on the surgical outcome. Korean J Urol 48(9):897–902

    Article  Google Scholar 

  23. 23.

    Jeldres C, Bensalah K, Capitanio U, Zini L, Perrotte P, Suardi N, Tostain J, Valeri A, Descotes JL, Rambeaud JJ, de La Taille A, Salomon L, Abbou C, Patard JJ, Karakiewicz PI (2009) Baseline renal function, ischaemia time and blood loss predict the rate of renal failure after partial nephrectomy. BJU Int 103(12):1632–1635. https://doi.org/10.1111/j.1464-410X.2008.08258.x

    Article  PubMed  Google Scholar 

  24. 24.

    Veccia A, Antonelli A, Uzzo RG, Novara G, Kutikov A, Ficarra V, Simeone C, Mirone V, Hampton LJ, Derweesh I, Porpiglia F, Autorino R (2020) Predictive value of nephrometry scores in nephron-sparing surgery: a systematic review and meta-analysis. Eur Urol Focus 6(3):490–504. https://doi.org/10.1016/j.euf.2019.11.004

    Article  Google Scholar 

  25. 25.

    Volpe A, Blute ML, Ficarra V, Gill IS, Kutikov A, Porpiglia F, Rogers C, Touijer KA, Van Poppel H, Thompson RH (2015) Renal ischemia and function after partial nephrectomy: a collaborative review of the literature. Eur Urol 68(1):61–74. https://doi.org/10.1016/j.eururo.2015.01.025

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Contributions

Conception and design of the study: ES. Data acquisition: CA, UB. Data analysis and interpretation: CA. Drafting the manuscript: CA, ES, MIG. Revision of the manuscript: OG, KT. Final approval of the manuscript before the submission: SB.

Corresponding author

Correspondence to Cagri Akpinar.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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.

Informed consent

All participants have given informed consent before inclusion in the present study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

Keywords

  • Artery-only clamping
  • Artery–vein clamping
  • Partial nephrectomy
  • Renal function