Comparison of Renal Artery vs Renal Artery-Vein Clamping During Partial Nephrectomy: A System Review and Meta-Analysis

Abstract

Background: Although artery-only (AO) clamping has been proposed to minimize ischemic renal damage compared with artery-vein (AV) clamping, the benefit of AO clamping during laparoscopic partial nephrectomy (LPN) is still controversial. We performed a systematic review and meta-analysis to test the difference between AO clamping and AV clamping in partial nephrectomy (PN). Materials and Methods: A systematic review of the literature on PubMed, Web of Science, the Cochrane Library, and Embase was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement to search-related studies. Data were extracted using a reporting checklist proposed by the Meta-analysis of Observational Studies in Epidemiology Group. RevMan 5.3 software and Stata 12.0 were used to do meta-analysis. Results: The present meta-analysis included 2 retrospective and 3 prospective studies, including 242 patients who underwent AO clamping and 369 patients who underwent AV clamping, which compared AO and AV clamping in LPN for renal cell carcinoma. At baseline, no statistically significant differences were detected between AO and AV clamping groups in terms of body mass index (p = 0.23), tumor size (p = 0.95), but AO clamping group had significantly lower RENAL Score (fixed effects [FE]: weighted mean difference [WMD]: 0.36, p = 0.007). For surgical outcomes analysis, no significant difference was detected regarding to warm ischemia (p = 0.58), operating time (p = 0.40), transfusion rate (p = 0.58), and estimated blood loss (p = 0.35) between two groups. The assessment of renal function by creatinine value both at the early postoperative (p = 0.36) and at last follow-up (p = 0.38) revealed no difference. There was no significant difference in estimated glomerular filtration rate (eGFR) (p = 0.62), and at the early postoperative percentage decrease of eGFR (p = 0.79). However, a higher percentage decrease of eGFR decrease at last follow-up was demonstrated for the AV clamping group (FE: WMD: 2.42, p < 0.00001). Conclusion: These results suggest that AO clamping might be a better choice for PN in long term. Randomized controlled trial studies with larger sample numbers and long-term follow-up and split renal function assessment should be conducted in the future to confirm our conclusion.

Keywords: partial nephrectomy; renal artery clamping; renal artery-vein clamping.