Meta-Analysis Of Selective Arterial Clamping And Main Arterial Clamping During Nephron Sparing Surgery

Objective To evaluate the clinical efficacy and safety of selective arterial clamping(SAC)and main arterial clamping(MAC)during nephron sparing surgery(NSS).Method Databases including Pub Med,EMBASE,the Cochrane Library,CNKI,Wan fang data and CMB were systematically searched for clinical studies comparing selective arterial clamping and main arterial clamping during nephron sparing surgery published from January 1993 to November 2016.Data were extracted and evaluated by two researchers independently according to the inclusion criteria and exclusion criteria.The quality of studies was assessed according to the Newcastle-Ottawa Scale(NOS).Then collected date were analyzed with Rev Man5.3 software supplied by Cochrane Collaboration.Result 12 retrospective studies involving 1369 patients who underwent robotic-assisted NSS or laparoscopic NSS were included.Patients who underwent selective arterial clamping during NSS were allocated into SAC group,and patients underwent main arterial clamping during NSS were allocated into MAC group.There were 669 patients in the SAC group and 700 patients in the MAC group.Meta-analysis revealed that there are no differences in age,BMI,tumor size,RENAL nephrometry score,pre-estimated glomerular filtration rate(e GFR)(P>0.05).No significant differences were observed in operative time between SAC group and MAC group during robotic-assisted NSS(MD=-1.44,95%CI:-25.31~22.43,P>0.05).The MAC group had longer operative time than MAC group during laparoscopic NSS(MD=10.12,95%CI:1.65~18.60,P<0.05).But our Meta-analysis showed no differences in estimated blood loss(MD=15.32,95%CI:-7.51~38.16,P>0.05),transfusion rate(OR=0.58,95%CI:0.25~1.36,P>0.05),urinary leak(OR=2.09,95%CI : 0.74~5.88,P>0.05),complication(Clavien grade?3)(OR=1.02,95%CI:0.49~2.15,P>0.05),positive margin rate(OR=0.90,95%CI:0.30~2.67,P>0.05).Patient in SAC group had a lower change in e GFR(MD=11.34,95%CI:5.58~17.11,P<0.05)and lower percent change in e GFR (MD=17.19,95%CI:10.63~23.76,P<0.05)in 1week postoperatively.No significant differences in the rate of decrease in e GFR at 1 month(MD=0.92,95%CI:-0.84~2.68,P>0.05)and 3 month(MD=5.47,95%CI:-0.28~11.22,P=0.06)and the rate of CKD ?3 stage(OR=1.32,95%CI:0.52~3.37,P>0.05).Conclusion nephron sparing surgery with.selective arterial clamping is safe and feasible,resulting in superior short-term renal function.But the superiority of selective arterial clamping in preservation of intermediate-term and long-term renal function remained to be evaluated in the future.Our conclusion are needed to be confirmed by more high quality,large-scale randomized controlled trials because of the limitation of the quality of studies and small sample.