Back to Program


Comparison of Hilar Clamping and Non-Hilar Clamping Partial Nephrectomy for Tumors Involving a Solitary Kidney
Matthew F. Wszolek, MD1, Patrick A. Kenney, MD1, Yoojin Lee, MPH2, John A. Libertino, MD1.
1Lahey Clinic, Burlington, MA, USA, 2Tufts Medical Center, Boston, MA, USA.

Background::
To compare outcomes of patients undergoing hilar clamping and non-hilar clamping partial nephrectomy for tumors involving a solitary functional kidney.
Methods:
Between 1990 and 2009, 104 partial nephrectomies, excluding bench and auto-transplant procedures, were performed on solitary functional kidneys. An institutional review board-approved retrospective review was performed analyzing patient demographics, operative data, complications, oncologic outcomes and estimated glomerular filtration rate (GFR). GFR was calculated using the abbreviated Modification of Diet in Renal Disease equation. Preoperative GFR was compared to Nadir GFR (lowest measured GFR within 100 days postoperatively) and to Late GFR (GFR 101-365 days postoperatively). Chi-square test, Wilcox-two sample test, Fisher’s exact test and Kaplan-Meier estimator were utilized to compare the clamping and non-clamping groups.
Results:
29 partial nephrectomies with hilar clamping and 75 partial nephrectomies without hilar clamping were performed. Mean follow-up equaled 4.7 years. There was no difference in tumor size, location, and number of tumors resected between the two groups. Mean ischemia time for the clamping group was 25 minutes. Surgical time was shorter in the non-clamping group (median: 245 vs. 270 minutes, mean: 259 vs. 314 minutes, p=0.02). There was no difference in intra-operative estimated blood loss, transfusion requirement or length of hospital stay. The complication rate and spectrum of complications were similar between the two groups. Regarding oncologic outcomes, surgical margin positivity rate was higher in the clamping group (21% vs. 5%, p=0.01), however the local recurrence rate between the two groups was similar. The clamping and non-clamping groups had similar overall and cancer specific survival. The two groups had similar preoperative GFR and Nadir GFR. The non-clamping group had a significantly smaller decrement in Late GFR (median: 0 vs. 10 mL/min, mean: 6.6 vs. 15.4 mL/min, p=0.01) and a significantly smaller percent decrease in Late GFR (median: 0 vs. 22%, mean: 12% vs. 28%, p=0.01) than the clamping group.
Conclusions:
In our analysis, partial nephrectomy without hilar clamping in solitary kidneys provides similar complications and cancer control when compared to partial nephrectomy with hilar clamping. Partial nephrectomy without clamping was associated with superior preservation of renal function in the period of 101-365 days after surgery.


Back to Program