Partial Nephrectomy for Stage I Renal Cell Carcinoma: On-clamp or Off-clamp?

Objective Partial nephrectomy represents the gold standard surgical procedure for the treatment of small renal cortical tumors. Tumor resection may be performed with the following techniques: on-clamp (warm or cold ischemia) and off-clamp (zero-ischemia). We aimed to share our experience with these two techniques and compare treatment outcomes in the present study. Materials and Methods Patients who have undergone open partial nephrectomy for clinical stage I renal cell carcinoma in our department between 2008 and 2012 were enrolled. Group 1 comprised patients with off-clamp technique and group 2 with on-clamp technique. Demographic data, length of operation, length of hospitalization, preoperative estimated glomerular filtration rate (eGFR) and postoperative eGFR on the last visit, complications and requirement of additional procedures, pathologic stage, and surgical margin status were compared between the groups retrospectively. Results A total of 73 patients, 40 in group 1 and 33 in group 2, were included in the study. Mean age, rate of comorbidities, R.E.N.A.L. nephrometry scores, preoperative eGFR, length of operation, length of hospitalization, complications, surgical margin status and additional procedure requirement did not differ significantly between the groups. Transfusion requirement was higher in group 1, however, it did not reach statistical significance (0.7±1.2 U vs. 0.2±0.5 U, p=0.066). After a median follow-up of 27 months for group 1 and 33 months for group 2, postoperative eGFR values were also similar (72.6±31.0 ml/min/1.73 m2 vs. 78.3±22.3 ml/min/1.73 m2, p=0.651). Conclusion Both surgical techniques, on-clamp and off-clamp partial nephrectomy, can be performed according to the surgeons’ preferences safely with similar outcomes