Comparison of Hilar Clamping Techniques in Partial Nephrectomy: Is Artery Only Clamping Beneficial?

Abstract

Hilar clamping is widely adopted in open partial nephrectomy, which is a treatment option for small renal cancer to reduce blood loss and improve surgical exposure, but whether to clamp either only artery or both artery and vein remains controversial. The purpose of this study is to determine whether artery only (AO) clamping is more beneficial than en bloc clamping by comparing perioperative variables in patients who underwent partial nephrectomy with either AO clamping or en bloc clamping. Eighty-eight patients with T1 renal tumor who underwent open partial nephrectomy with either AO or en bloc clamping between 2015 and 2018 at our institution were enrolled. They were randomly divided into two groups: AO group (n = 43) and artery and vein (AV) group (n = 45). Renal function was evaluated by serum creatinine (SCr) and differential renal function as determined by mercaptoacetyltriglycine renogram. AO clamping was associated with less total renal functional decrease until postoperative 7th day (P < 0.05). After postoperative 15th day, however, there was no significant difference in total renal functional impairment between AO and AV groups. There was also no significant difference in differential renal function change. Furthermore, AO clamping caused more blood loss and hemoglobin (Hb) decrease than en bloc clamping (P < 0.05). AO clamping is no more beneficial than en bloc clamping in partial nephrectomy, presenting with not significantly better long-term postoperative renal function than en bloc clamping.