title: A retrospective analysis of laparoscopic partial nephrectomy with segmental renal artery clamping and factors that predict postoperative renal function.
abstract: To evaluate the feasibility and efficiency of laparoscopic partial nephrectomy (LPN) with segmental renal artery clamping, and to analyse the factors affecting postoperative renal function.
  
  
  
  We conducted a retrospective analysis of 466 consecutive patients undergoing LPN using main renal artery clamping (group A, n = 152) or segmental artery clamping (group B, n = 314) between September 2007 and July 2015 in our department. Blood loss, operating time, warm ischaemia time (WIT) and renal function were compared between groups. Univariable and multivariable linear regression analyses were applied to assess the correlations of selected variables with postoperative glomerular filtration rate (GFR) reduction. Volumetric data and estimated GFR of a subset of 60 patients in group B were compared with GFR to evaluate the correlation between these functional variables and preserved renal function after LPN.
  
  
  
  The novel technique slightly increased operating time, WIT and intra-operative blood loss (P < 0.001), while it provided better postoperative renal function (P < 0.001) compared with the conventional technique. The blocking method and tumour characteristics were independent factors affecting GFR reduction, while WIT was not an independent factor. Correlation analysis showed that estimated GFR presented better correlation with GFR compared with kidney volume (R(2) = 0.794 cf. R(2) = 0.199) in predicting renal function after LPN.
  
  
  
  LPN with segmental artery clamping minimizes warm ischaemia injury and provides better early postoperative renal function compared with clamping the main renal artery. Kidney volume has a significantly inferior role compared with eGFR in predicting preserved renal function.
authors.affiliation: Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Pu
authors.initials: P
authors.lastname: Li
authors.affiliation: Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Qin
authors.affiliation: Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Cao
authors.affiliation: Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Lv
authors.affiliation: Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Xiaoxin
authors.initials: X
authors.lastname: Meng
authors.affiliation: Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Xiaobing
authors.initials: X
authors.lastname: Ju
authors.affiliation: Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Lijun
authors.initials: L
authors.lastname: Tang
authors.affiliation: Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China. mengxiaoxin72@163.com.
authors.forename: Pengfei
authors.initials: P
authors.lastname: Shao
mesh_terms: D003250:Constriction; D005240:Feasibility Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000473:pathology / Q000502:physiology; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D009929:Organ Size; D011379:Prognosis; D020127:Recovery of Function; D012077:Renal Artery / Q000601:surgery*; D012189:Retrospective Studies
keywords: kidney volume; partial nephrectomy; renal function; segmental renal artery