Abstract
ObjectsIschemia-reperfusion injury is very harmful in partial nephrectomy (PN) in renal cell carcinoma (RCC). It is important to choose an appropriate surgical method to reduce ischemia-reperfusion injury. To compare the impact of segmental artery clamping (SAC) and main artery clamping (MAC) on some clinical data of the patients underwent PN. MethodsStudies from January 2008 to November 2019 were identified by electronical search of the English databases including PubMed, EMBASE, the Cochrane Library and Chinese database including Wanfang, VIP and CNKI without language restriction. Two reviewers were involved in the trial. The impact on operation time(OT), Warm ischemia time (WIT), length of stay in hospital (LOS), blood transfusion rate, postoperative complication rate, Clavien classification ≥3 and positive surgery margin (PSM) were evaluated using Stata software, and standardized mean difference (SMD)%(for the continuous data) and the pooled odds ratios (ORs) (used for counting data) with 95% confidence interval (CI) were used as effect indicators. ResultsThirty-two studies were eligible. SAC showed characteristics through decreasing 1 week post-operative percentage changes of renal function [SMD:-0.973, 95% CI (-1.414, -0.532), P=0.000], 1 month post-operative percentage change in eGFR [SMD:-0.411, 95CI (-0.769, -0.053), P=0.025] and percentage change of eGFR of the affected kidney 3 months postoperatively between SAC and MAC group [SMD:-0.914, 95%CI (-1.662, -0.617), P=0.000]. During sub-group analysis, SAC had longer OT [SMD:0.562, 95CI (0.252, 0.871), P=0.000] compared to MAC group. However, no difference was observed between the two groups in OT, WIT LOS, blood transfusion rate, postoperative complication rate, Clavien classification ≥3 and PSM%. ConclusionsSAC has more superiority with advantages in short term post-operative renal function recovery compared to MAC. Whether to use SAC or MAC depends on tumor size, location, surgical modality, and surgeon’s judgements.