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Different methods of hilar clamping during partial nephrectomy: Impact on renal function
Author(s) -
Lee Jeong Woo,
Kim Hwanik,
Choo Minsoo,
Park Yong Hyun,
Ku Ja Hyeon,
Kim Hyeon Hoe,
Kwak Cheol
Publication year - 2014
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.12255
Subject(s) - medicine , renal function , nephrectomy , clamping , ischemia , urology , renal ischemia , kidney , reperfusion injury , mechanical engineering , engineering
Objectives To evaluate the impact of different hilar clamping methods on changes in renal function after partial nephrectomy. Methods We analyzed the clinical data of 369 patients who underwent partial nephrectomy for a single renal tumor of size ≤4.0 cm and a normal contralateral kidney. Patients were separated into three groups depending on hilar clamping method: non‐clamping, cold ischemia and warm ischemia. Estimated glomerular filtration rate was examined at preoperative, nadir and 1 year postoperatively. Percent change in estimated glomerular filtration rate was used as the parameter to assess the renal functional outcome. Results Percent change in nadir estimated glomerular filtration rate in the non‐clamping group was significantly less compared with the cold ischemia and warm ischemia groups ( P < 0.001). However, no significant differences among the groups were noted in percent change of estimated glomerular filtration rate at 1 year ( P = 0.348). The cold ischemia group had a similar serial change of postoperative renal function compared with the warm ischemia group. Percent change in 1‐year estimated glomerular filtration rate increased with increasing ischemia time in the cold ischemia ( P for trend = 0.073) and warm ischemia groups ( P for trend = 0.010). On multivariate analysis, hilar clamping (both warm ischemia and cold ischemia) were significantly associated with percent change in nadir estimated glomerular filtration rate, but not in 1‐year estimated glomerular filtration rate. Conclusions Non‐clamping partial nephrectomy results in a lower percent change in nadir estimated glomerular filtration rate, whereas it carries an estimated glomerular filtration rate change at 1 year that is similar to partial nephrectomy with cold ischemia and warm ischemia. Cold ischemia and warm ischemia provide a similar effect on renal function. Therefore, when hilar clamping is required, minimization of ischemia time is necessary.