title: Safety and Postoperative Outcomes of Regional versus Global Ischemia for Partial Nephrectomy: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  To analyze current evidence comparing the safety and outcomes of regional and global ischemia for partial nephrectomy (PN).
  
  
  METHODS
  A systematic search of the PubMed and Web of Science databases was conducted in May 2014 to identify studies comparing the safety and outcomes of regional and global ischemia for PN. A systematic review and meta-analysis was also performed.
  
  
  RESULTS
  Six retrospective observational studies were selected for the analysis, including 363 patients who underwent PN (162 regional ischemia and 201 global ischemia cases). Operation times were not statistically different [weighted mean difference (WMD) = 20.35 min, 95% CI: -0.28-40.97, p = 0.05], but estimated blood loss was significantly higher in the regional ischemia group (WMD = 52.04 ml, 95% CI: 14.30-89.78, p = 0.007) than in the global ischemia group. Complication rates [odds ratio (OR) = 1.16; 95% CI: 0.63-2.15, p = 0.63] and blood transfusion rates (OR = 1.85; 95% CI: 0.86-4.01, p = 0.12) of the two groups were not significantly different. The regional ischemia group showed better postoperative renal function (WMD = 4.23 ml/min, 95% CI: 2.61-5.85, p < 0.00001) than the global ischemia group, and all cases in the regional ischemia group showed negative margins.
  
  
  CONCLUSIONS
  Regional ischemia is as safe to perform as global ischemia, and the former leads to better postoperative renal functions than the latter. These findings support the application of regional ischemia for PN.
authors.affiliation: Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, PR China.
authors.forename: Yiduo
authors.initials: Y
authors.lastname: Wang
authors.forename: Huan
authors.initials: H
authors.lastname: Qu
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.forename: Shuqiu
authors.initials: S
authors.lastname: Chen
authors.forename: Bin
authors.initials: B
authors.lastname: Xu
authors.forename: Kai
authors.initials: K
authors.lastname: Lu
authors.forename: Chunhui
authors.initials: C
authors.lastname: Liu
authors.forename: Tao
authors.initials: T
authors.lastname: Tao
authors.forename: Yu
authors.initials: Y
authors.lastname: Yang
authors.forename: Ming
authors.initials: M
authors.lastname: Chen
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D057668:Bloodless Medical and Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D016009:Chi-Square Distribution; D006801:Humans; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D016017:Odds Ratio; D061646:Operative Time; D015427:Reperfusion Injury / Q000209:etiology / Q000517:prevention & control; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D052096:Warm Ischemia / Q000009:adverse effects