Parsiyel nefrektomi yapılan böbrek tümörlü olgularda pedikül klempajı ile parenkimal klempajın post-operatif sonuçlarının karşılaştırılması / Comparison of the post-operati̇ve results of pedicular clamping and parenchymal clamping in renal tumors with partial nephrectomy
OBJECTİVE: Although partial nephrectomy is the gold standart for <4cm and peripheral tumors, today between 4-7cm in the tumor successfully implemented. Vascular or parenchymal clamping techniques can be performed to decrease bleeding during partial nephrectomy. Our aim is to evaluate the postoperative results of both clamping techniques. MATERIAL AND METHODS : 64 patients with 2-6cm renal mass underwent partial nephrectomy at our institution. Thoracoabdominal incision was made over the 9, 10, 11 or 12. ribs according to the localization of the mass and than rib was removed to get into retroperitoneal space. After Gerota's fascia was opened kidney freed from surrounding tissues. Selective renal parenchymal clamping was performed around the tumor, 1 to 2 cm proximal to the line of resection, using a large bowel clamp. In the other group, a bulldog clamp was placed to renal arteries to control intraoperative bleeding. The prominent intrarenal vessels within the transected parenchyma were suture ligated and when it was entered, the collecting system was closed with continuous sutures. The renal defect was closed on itself using absorbable sutures. All data concerning ischemia time, operative time, estimated blood loss, postoperative serum creatinine and GFR levels were recorded and compared. RESULTS: The study included 64 patients 36 (56.3%) males and 28 (43.8%) were women. The average age of all patients was 55,78 (25-78), the average BMI is 22,44±2,16 (19-27) kg/m² and the mean tumor diameter is 4.1±0.9cm. The median time of selective clamping was 18,42 ±4,06 (8-27)minutes and vascular clamping was 17,94±3,89minutes (8-27). The median operating time and intraoperative blood loss were 87,73±13,56minutes and 377,7±65,5ml (180-510) in parenchymal clamping group, 84,65±12,43minutes and 243,2±80,6ml (100-420) in vascular clamping group. The median pre-op/post-op creatinine and GFR values were 0,80±0,06mg/dl (0,70-0,97), 0,83±0,05mg/dl (0,75-0,98), 95,7±13,7ml/dk/1.73m2 (70-117), 91,8±13,2ml/dk/1.73 m2 (66-116) in parenchymal clamping group and 0,80±0,06mg/dl (0,69-0,98), 0,83±0,05mg/dl (0,70-0,99), 92,9±14,8ml/dk/1.73 m2 (72-116) , 88,7±14,3ml/dk/1.73m2 (68-116) in vascular clamping group. In the long term follow up of patients with lokal recurrence or systemic metastases were not observed. CONCLUSİON: There were no statistically significant differences between the two groups regarding age, BMI, tumor size, surgical margin, postoperative creatinine and GFR, ischemia time and operation time. There was a significantly higher mean blood loss in patients without vascular occlusion.