Comparison of clamping strategies in minimally invasive partial nephrectomy for cT1 tumors.

Objectives: To determine whether artery only (AO) clamping promises any advantage over artery and vein (AV) clamping in patients undergoing partial nephrectomy with minimally invasive surgical techniques.
Material and Methods: We retrospectively analyzed the data of 68 partial nephrectomy patients who were treated with minimally invasive techniques (robot-assisted laparoscopic or pure laparoscopic) for solitary, unilateral, cT1 renal masses during the period of 2008-2019 in a single institution. Patients were divided into two groups according to clamping strategy (AO and AV). The two groups were compared to each other in terms of perioperative outcomes and long-term functional results.
Results: The mean patient age and median follow-up period were 56.8 ± 10.8 years and 13.5 (9-44.5) months, respectively. Warm ischemia time, estimated blood loss, transfusion rate and length of hospital stay were similar between the two groups, while operative time was significantly higher in the AO clamping group ( p  = .726, p  = .604, p  = .675, p  = .103, and p  = .038, respectively). Patients who underwent AV clamping had a significantly lower estimated glomerular filtration rate (eGFR) and higher chronic kidney disease rates six months postoperatively ( p  = .001 and p  = .044, respectively) and at the last follow-up ( p  = .020 and p  = .048, respectively). The percentage of eGFR change at six months and the last follow-up was higher in the AV clamp group but the difference was not statistically significant ( p  = .056 and p  = .082, respectively).
Conclusions: Our findings suggest AO clamping is safe and comparable to AV clamping. In our study, AO clamping was found to be superior to AV in terms of long-term eGFR preservation.