Comparison Of Selective And Main Renal Artery Clamping In Partial Nephrectomy: A Meta-analysis

Objective: To compare the safety and efficency of selective and main renal artery clamping in partial nephrectomy and provide evidence for treating renal tumors.Methods: A systematic search of the electronic databases, including PubMed、Web of Science、Cochrane library、CNKI、CBM and Wan Fang database(from the date of their establishments to December 2014) was done. We retrieved literatures about comparing selective and totally clamping of the renal artery in partial nephrectomy. At the same time reference documents were involved by manual searches. The literature screening, quality assessment, data extraction of the included studies were completed by two independent researchers according to inclusion and exclusion criteria. A meta-analysis was conducted using RevMan 5.2 software.Results: A total of 10 controlled clinical studies were enrolled, including 787 patients, of whom 285 were treated with selective artery clamping group and the other 502 were treated with main artery clamping group. Meta-analysis showed statistically significant difference between selective artery clamping and main artery clamping groups in estimated blood loss( SWD=39.07, 95%CI 4.66~73.49, P=0.03), perioperative renal function( SWD=12.44, 95%CI 6.61~18.27, P < 0.0001), percentage of perioperative renal function changes( SWD=14.78, 95%CI 10.46~19.11, P < 0.00001), 3-month renal functional( SWD=13.42, 95%CI 6.40~20.43,P=0.0002), percentage of 3-month renal functional changes(SWD=8.32, 95%CI 3.92~12.71,P=0.0002). Those difference were in favor of selective artery clamping group, especially showed better postoperative renal function. The differences in operation time, hospital stay, positive surgical margin, transfusion, complications were not statistically significant.Conclusions: This meta-analysis suggests that selective renal artery clamping partial nephrectomy is a safe surgical approach and perform better renal function preservation compare with main renal artery clamping. Given the inherent limitations of the included studies, future well-designed randomized controlled trials are required to confirm our findings.