SP208SELECTIVE PARENCHYMA CLAMPING DURING PARTIAL NEPHRECTOMY PROVIDES BETTER FUNCTIONAL OUTCOMES THAN TRADITIONAL VASCULAR CLAMPING

Abstract

Introduction and Aims: Partial nephrectomy (PN) for renal cell carcinoma (RCC) is usually performed with the renal artery being temporary clamped to stop bleeding from the tumor's site during resection. Clamping of the artery leads to warm ischemia of parenchyma, which is known as a risk factor of developing acute kidney injury (AKI) and chronic kidney disease (CKD). Urine Neutrophil gelatinase-associated lipocalin (uNGAL) has been recently used as a promising biomarker for early diagnosing of AKI. The aim of our study was to perform PN without total warm ischemia of the kidney by using specially designed clamps for renal parenchyma and to compare the dynamics of uNGAL level after surgery with traditional vascular clamping (VC group) and selective parenchyma clamping (PC group). Methods: Between 2011 and 2014 a total number of 110 open, laparoscopic and robot-assisted PN in patients with RCC stage T1-2N0M0 was performed. Three types of renal parenchyma clamps were utilized (patented inventions): one for laparoscopic and robotic PN and two types for open procedures. There were 86 and 24 pts in VC and PC groups, respectively, who were matched for age, sex, tumor stage, size and location. The uNGAL samples were taken before surgery and 2, 4, 8 and 24 hours after the procedure. The estimated glomerular filtration rate (eGFR, CKD-EPI) was measured 24 hours and 1 year after surgery to evaluate the deterioration of kidney function. Results: The uNGAL levels and eGFR didn't differ significantly before surgery between VC and PC groups but uNGAL were higher in VC group at all control points (Figure 1). There was a significantly greater depression of eGFR in VC group than in PC group 24 hours and 1 year after the procedure (Figure 2). No serious complications or reinterventions were registered. Cancer-specific survival rate in the groups was 100% after 12 months. Conclusions: PN may be performed without total warm ischemia by using specially designed parenchyma clamps and this technique provides better preservation of renal function compared to conventional PN immediately and 12 months after the operation. The uNGAL level starts to grow just after the PN, however with significantly more gain after the VC. (Table Presented).