title: Renal artery occlusion during nephron-sparing surgery: retrospective review of 301 cases.
abstract: OBJECTIVE
  Temporary occlusion of the renal artery during nephron-sparing surgery may facilitate complete tumor resection and reduce operative bleeding. However, it may also entail a greater risk of ischemic kidney damage. In contrast, when vascular occlusion is not applied, the risk of bleeding, as well as the risk of positive margins, may be increased. To study these issues, we retrospectively evaluated our results with nephron-sparing surgery for kidney masses using renal artery occlusion compared with patients in whom vascular occlusion was not applied.
  
  
  METHODS
  From 1988 to 2003, 301 consecutive patients underwent nephron-sparing surgery for a kidney mass at our institutions. At the surgeons' discretion, the renal artery was temporarily occluded in 181 patients (60%) and was not in 120 (40%).
  
  
  RESULTS
  No statistically significant differences were found between the two groups regarding blood loss, transfusion rates, and overall complication rates. The loss of the renal unit because of ischemia was noted in 2 patients (1.2%) after renal artery occlusion and in none of the nonoccluded group. Positive tumor margins were found in 5 patients (4.2%) in the nonoccluded group and in 1 patient (0.6%) in the vascular occlusion group.
  
  
  CONCLUSIONS
  Our results suggest that although vascular occlusion during nephron-sparing surgery may increase the risk of permanent kidney damage, patients with no vascular occlusion may have a greater risk of positive tumor margins after surgery. These two factors should be taken into consideration and could be discussed with the patient when attaining informed consent.
authors.affiliation: Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel.
authors.forename: Mordechai
authors.initials: M
authors.lastname: Duvdevani
authors.forename: Yoram
authors.initials: Y
authors.lastname: Mor
authors.forename: Alexander
authors.initials: A
authors.lastname: Kastin
authors.forename: Menachem
authors.initials: M
authors.lastname: Laufer
authors.forename: Andrei
authors.initials: A
authors.lastname: Nadu
authors.forename: Jacob
authors.initials: J
authors.lastname: Golomb
authors.forename: Dorit
authors.initials: D
authors.lastname: Zilberman
authors.forename: Ofer
authors.initials: O
authors.lastname: Nativ
authors.forename: Jacob
authors.initials: J
authors.lastname: Ramon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods*; D009399:Nephrons; D012077:Renal Artery; D012189:Retrospective Studies