A comparative analysis of robotic partial nephrectomy with selective versus main artery clamping in the management of early-stage kidney cancer

Objective To compare the clinical outcomes of selective artery (SAC) with main artery (MAC) clamping of robotic partial nephrectomy (RPN) in patients with early-stage (cT1N0M0) renal masses. Methods Between October 2016 and September 2018, a total of 343 cT1 renal mass patients receiving RPN with SAC (n=21) or MAC (n=322) in our center, were retrospectively analyzed. There were 13 males and 8 females in SAC group with a mean age of (53.1±10.6) years old, mean tumor size of(2.5±0.7)cm, and mean R. E.N.A.L. score of 6.2±1.5. There were 149 males and 173 females in MAC group, with a mean age of (51.6±12.3) years old, mean tumor size of(3.5±1.4)cm, and mean R. E.N.A.L. score of 7.9±1.6. There was statistical significance between two groups in tumor size and R. E.N.A.L score(P 0.05). Perioperative outcomes and follow-up data were compared between the two matched groups. Results There was no significant differences resulted regarding operating time[(127.0±54.8)min vs.(130.0±49.9)min], blood loss[(166.0±173.5)ml vs.(124.0±101.0)ml], ischemia time[(18.9±6.4) vs.(18.1±5.8)min], hospital stay[(8.7±3.4)d vs.(8.5±2.5)d], incidences of complications (28.6% vs.19.0%), surgical conversions (0 vs.2.4%), transfusions (4.8% vs.2.4%) or positive surgical margin(0 vs.0) and malignant pathological outcomes(95.2% vs.92.9%). The follow-up durations ranged from 3 to 24 months with a mean duration of 9.1 and 12.4 months in SAC and MAC, respectively. At the end of follow-up, the two groups had similar decrease in estimated glomerular filtration rate [(7.5±17.2)% vs.(12.1±18.2)%, P =0.466], but the difference was statistically significant with ECT-GFR both of function reduction in the operated kidney [(21.6±14.6)% vs.(38.4±20.7)%, P =0.001] and in two kidneys [(2.5±16.4)% vs.(14.8±20.0)%, P=0.002]. Conclusions Robotic partial nephrectomy with selective vascular control lead to better postoperative renal function compared with main vascular clamped PN techniques and does not lead to a higher surgical risk following a strict patient selection criteria. Key words: Branching renal artery clamping; Partial nephrectomy; Robotic surgery