| Summary: | Objects: To compare the safety and clinical efficacy of selective clamping and hilar clamping during minimally invasive partial nephrectomy.
Methods: Relevant studies were searched from the databases PubMed, EMBASE, and Web of Science till 1st October 2017. Crude odds ratios (ORs) or standardized mean differences (SMD) with 95% confidence intervals (CIs) were calculated to evaluate the strength of associations. Bagg’s funnel plots and Egger’s regression test were used to evaluate publication bias.
Results: A total of 9 relevant studies including 1576 patients were enrolled in this meta-analysis. Totally, selective clamping group had significantly greater estimated blood loss (SMD = 0.28, 95% CI: 0.15-0.42) than hilar clamping group, while no statistical differences were detected in operative time (SMD = -0.02, 95% CI: -0.33-0.29), warm ischemia time (SMD = -0.12, 95% CI: -0.61-0.38), and length of stay (SMD = -0.03, 95% CI: -0.26-0.20) between two groups. Moreover, we found no significant differences between two groups in overall complications (OR = 0.86, 95% CI: 0.60-1.22), positive surgical margins (OR = 1.47, 95% CI: 0.54-3.96), urinary leakage (OR = 2.48, 95% CI: 0.64-9.70) and blood transfusion (OR = 1.10, 95% CI: 0.37-3.28). In the aspect of renal function (one week after surgery), selective clamping group indicated better renal function with lower change and lower percent change in glomerular filtration rate (SMD = 0.72, 95% CI: 0.34-1.10; SMD = 0.76, 95% CI:0.56-0.96, respectively). However, renal function between two groups emerged no obvious difference in 3-month and 6-month follow-up (SMD = -0.00, 95% CI = -0.68-0.67; SMD = 0.52, 95% CI: -0.15-1.20, respectively).
Conclusion: Comparing with hilar clamping, selective clamping showed better short-term postoperative renal function, along with more estimated blood loss. More comprehensive studies with longer follow-up are required in the future.
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