Category: Laparoscopic/ Robotic: Other

MP25-6 - Comparison of short-term renal function change according to renal hilar-clamp and width of safety margin after laparoscopic partial nephrectomy

Sun, Sep 23
10:00 AM - 12:00 PM

Introduction & Objective : To analyze the effect of renal hilar-clamp and width of safety margin on short-term renal function change after laparoscopic partial nephrectomy (LPN)


Methods :

We retrospectively reviewed 118 LPN cases between March 2008 and March 2017 in our hospital, of which 106 were enrolled in this study. The perioperative clinical data such as age, tumor size, operation time, estimated blood loss, hemoglobin decline, warm ischemic time, change of eGFR (by MDRD), margin status(including the width of the peripheral (cortical) and central (deep) parenchymal margin) were retrospectively gathered. Patients were devided into 3 groups according to margin width and hilar clamp method, resection (minimal margin >1mm) with hilar-clamp (group 1) enucleoresection (minimal margin < 1mm) with renal hilar-clamp (group 2) and enucleoresection (minimal margin < 1mm) with off-clamp (group 3).


Results :

The patient number of group 1, 2, and 3 were 30, 33, and 43, respectively. Age (mean 60.2, 58.5, 56.2 years old), mass size (mean 3.0, 3.3, 2.9 cm), operation (anesthesia) time (mean 182.4, 160.8, 167.3 min), estimated blood loss (mean 310.5, 308.4, 324.6, ml), hemoglobin decline (mean 1.60, 1.41, 1.74, g/dl), preoperative eGFR (mean 91.06, 95.36, 90.20, ml/min/1.73m2) were not different between groups. Tumor size, pathologic outcome, pT stage and complication rate were also not different between groups. Mean postoperative eGFR at 6 months was 79.31, 96.44, 90.40 ml/mim/1.73m2, peripheral parenchymal safety margin of the renal tumors was 2.45, 1.30, 0.67 mm, and the central parenchymal safety margin was 1.50, 0.26, 0.43 mm, and mean warm ischemic time were 24.1, 25.9, and 0 minutes in group 1,2,3 respectively. Postoperative eGFR at 6 months showed higher in group 2 than group 1 (p= 0.006).  However, there was no significant difference between the group 1 and 3, 2 and 3 (p= 0.090, 0.355). The percent change of postoperative eGFR was 86.58, 101.13, 100.22 % in group 1,2,3 respectively, and the percent change of postoperative eGFR in group 1 had a trend of significant decrease (p=0.055).


Conclusions :

When enucleoresection was performed, there was no difference in short-term renal function change between hilar-clamp and off-clamp (group 2 vs 3). When renal hilar-clamp was performed, however, there were significant differences in renal function change between the resection group and the enucleoresection group (group 1 vs 3). The minimal safety margin (preserved renal parenchymal volume) is a significant factor for minimal renal function loss after LPN.

Taek Sang Kim

Associate professor
Department of Urology, Kosin University Gospel Hospital
Busan, Pusan-jikhalsi, Republic of Korea

Su Hwan Kang

Assistant professor
Department of Urology, Kosin University Gospel Hospital
Busan, Pusan-jikhalsi, Republic of Korea

Su Hwan Park

Assistant Professor
Department of Urology, Kosin University Gospel Hospital
Busan, Pusan-jikhalsi, Republic of Korea

Won Tae Seo

Department of Urology, Kosin University Gospel Hospital
Busan, Pusan-jikhalsi, Republic of Korea

Seong Choi

Professor
Department of Urology, Kosin University Gospel Hospital
Busan, Pusan-jikhalsi, Republic of Korea

Hyun Yul Rhew

Professor
Department of Urology, Kosin University Gospel Hospital
Busan, Pusan-jikhalsi, Republic of Korea

Jae Young Joung

Department of Urology, Center for Prostate Cancer, National Cancer Center, Goyang, Korea
Goyang, Kyonggi-do, Republic of Korea