Abstract：Objective: To investigate the effect and feasibility of off-clamp retroperitoneal laparoscopic partial nephrectomy (RLPN) for T1N0M0 renal tumors. Methods: Retrospective comparative study was performed for two groups of patients with T1N0M0 renal tumors enrolled from March 2013 to September 2015. Off-clamp group was consisted of 27 cases who underwent RRLPN without renal hilar control, and on-clamp group included 36 cases who underwent RRLPN with total hilar control by the same surgeon (Fu Bin). Results: All procedures were performed successfully without conversion. The mean warm ischemia time for on-clamp group was (21.6±5.3)min. Off-clamp group had more bleeding, and longer tumor resection time than on-clamp group (113.6±26.3/46.2±12.5 mL; 5.3±3.2/4.3±1.2 min, respectively, P<0.05). There were no significant differences between the two groups in suturing time for renal mesenchymal defect, positive surgical margins, transfusion, complications and postoperative hospital stay time (P>0.05). Compared with on-clamp group, the results of eGFR 7 days and six months after surgery for off-clamp group were better (46.8±9.1/62.1±8.3)mL·min-1·1.73 m-2, (59.5±7.8/72.5±5.7)mL·min-1·1.73 m-2, respectively, (P<0.05);while the results of postoperative 1-year-eGFR were similar between two groups (76.5±7.9 / 68.8±9.7 mL·min-1·1.73 m-2,P>0.05). Furthermore, the average postoperative change rate of eGFR was statistically significant between off-clamp group and on-clamp group (-2.3/-7.6, P<0.05). No tumor recurrence and metastasis were occurred during 12-months follow-up for these patients. Conclusions: Off-clamp RRLPN is safe and feasible for T1N0M0 renal tumor with better renal function preservation, but more technically challenging.
[1] Ljungberg B, Cowan NC, Hanbury DC, et al. EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol, 2010,58(3):398-406.
[2] Lau WK, Blute ML, Weaver AL, et al. Matched comparison of radical nephrectomy vs nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin Proc, 2000,75(12):1236-1242.
[3] Pahernik S, Roos F, Röhrig B, et al. Elective nephron sparing surgery for renal cell carcinoma larger than 4 cm. J Urol, 2008,179(1):71-74.
[4] 李鸣,何志嵩,高江平,等.多中心肾癌临床特征分析.中华泌尿外科杂志,2010,31(2):77-80.
[5] 刘兆琼,傅斌,李兵才,等.泌尿外科腹腔镜手术236例分析.江西医药,2014,49(7):587-587.
[6] Berdjis N, Hakenberg OW, Zastrow S, et al. Impact of resection margin status after nephron-sparing surgery for renal cell carcinoma. BJU Int, 2006,97(6):1208-1210.
[7] Minervini A, di Cristofano C, Lapini A, et al. Histopathologic analysis of peritumoral pseudocapsule and surgical margin status after tumor enucleation for renal cell carcinoma. Eur Urol, 2009,55(6):1410-1418.
[8] 魏东,张伟,王鑫,等.肾癌多中心病灶和假包膜外肿瘤浸润的病理研究.中华泌尿外科杂志,2011,32(3):181-184.
[9] Mitsui Y, Shiina H, Arichi N, et al. Indocyanine green (ICG)-based fluorescence navigation system for discrimination of kidney cancer from normal parenchyma: application during partial nephrectomy. Int Urol Nephrol, 2012,44(3):753-759.
[10] Ginzburg S, Uzzo R, Walton J, et al. Residual Parenchymal Volume, Not Warm Ischemia Time, Predicts Ultimate Renal Functional Outcomes in Patients Undergoing Partial Nephrectomy. Urology, 2015,86(2):300-305.
[11] Thompson RH, Lane BR, Lohse CM, et al. Every minute counts when the renal hilum is clamped during partial nephrectomy. Eur Urol, 2010,58(3):340-345.
[12] Leslie S, Goh AC, Gill IS. Partial nephrectomy contemporary indications, techniques and outcomes. Nat Rev Urol, 2013,10(5):275-283.
[13] Kopp RP, Mehrazin R, Palazzi K, et al. Factors affecting renal function after open partial nephrectomy-a comparison of clampless and clamped warm ischemic technique. Urology, 2012,80(4):865-870.
[14] Wang HK, Qin XJ, Ma CG, et al. Nephrometry score-guided off-clamp laparoscopic partial nephrectomy: patient selection and short-time functional results. World J Surg Oncol, 2016,14(1):163.
