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Surgical Outcomes Of Non-hilar Clamping Partial Nephrectomy; An Updated Twenty Year Experience.
Justin M Zbrzezny1, William C Faust1, Marc D Manganiello1, Matthew F Wszolek1, Yoojin Lee2, John A Libertino1
1Lahey Clinic Medical Center, Burlington, MA;2Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
Non-clamping partial nephrectomy has superior renal outcomes and equivalent oncologic outcomes compared to hilar clamping partial nephrectomy in initial investigations. Potential hindrances to widespread acceptance include concerns over technical difficulty and the associated learning curve. Our purpose is to demonstrate durable renal, perioperative and oncologic outcomes from a multi-surgeon, single institution experience over the past twenty years.
695 non-clamping partial nephrectomies were performed at our institution between 1990 and 2010. 469 patients with inadequate follow up, familial renal cancer syndrome, solitary kidney, or benign pathology were excluded. Patient demographics, operative data, complications, oncological outcomes, and percent change of early and late glomerular filtration rate (GFR) of the remaining 226 patients were analyzed. Patients were placed into 3 chronological groups (1st third, 2nd third, 3rd third) based on date of surgery, and the above parameters were compared using Student's T-test to investigate changes over time.
Patient demographics, operative outcomes, complications, surgical margins, local recurrence, overall and disease specific survival, and percent change in eGFR were statistically similar among the three groups. Loss of renal function among the early and late time points was not observed. Over time more partial nephrectomies were performed for bilateral tumors (p=0.05), less were performed for advanced disease (p=0.05), and length of hospital stay decreased (p=0.05).
Over 20 years experience, non-clamping partial nephrectomy has durable and consistent outcomes in regards to postoperative renal function, peri-operative complications and disease specific survival. This supports an acceptable learning curve and potential widespread application of this technique.
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