Establishment of the risk assessment model of laparoscopic partial nephrectomy with segmental renal artery clamping for renal cell carcinoma / 中华泌尿外科杂志

ABSTRACT

Objective To establish a risk assessment model for laparoscopic partial nephrectomy (LPN) with segmental renal artery clamping (SRAC).Methods In the first stage,107 patients who underwent LPN with SRAC from December 2009 to September 2011 were retrospectively reviewed.There were 63 men and 44 women,aged from 11-80 years,mean (58.1 ±10.1) years.The blocking program of target arteries was dependent on the experience of the surgeon and CTA.After multiple Logistic regression analysis,variables used to build a nomogram were selected using a backward elimination scheme.Then,a model for a clamping program customized to the patient was designed.In the second stage,the surgical outcomes of 141 patients who subsequently underwent LPN-SRAC with the applied model from October 2011 to June 2014 were compared with those of the first stage patients.There were 84 men and 57 women,aged from 51-75years,mean (59.9 ± 8.6) years.Outcomes of two stages were compared.Results Five potential predictors were initially assessed including segmental renal artery angle,target artery diameter,and distance to the abdominal aorta,renal hilum,and kidney midline.The regression equation was then set up with Logistic regression analysis.Compared with the patients in the first stage,success rate of clamping in the second stage,with the help of the new SRAC model,was improved from 74.8％ (175/234) to 94.2％(227/241) (P ＜ 0.001),the total operative time was decreased from (88.6 ± 10.9) min to (80.2 ±16.6) min (P＜O.001),and operative blood loss was reduced from (198.7 ±111.6) ml to (168.5 ±117.8) ml (P =0.042).No obvious differences were observed in warm ischemia time,postoperative hospitalization,R.E.N.A.L nephrometry score,or number of final clamped branches.Conclusion The model for assuring clamping success was helpful in designing an SRAC program.