Reply from authors re: Ithaar H. Derweesh, Paul Russo. to Clamp or Not to Clamp the Main Renal Artery: The Debate Continues. Eur Urol 2014;66:720-21: Clamping Is a 'necessary' Evil, Not a Desirable Ideal

摘要

We address the four main issues raised in the editorial [1]. First, the concern about transfusion rates is fair; however, a closer look at our data shows that this issue is already being addressed [2]. Our data represent the very initial patients undergoing superselective, anatomic partial nephrectomy (PN) surgery and thus reflect, in part, the obligatory "developmental curve" inherent to a novel technique. Initially, we enrolled virtually all comers regardless of tumor complexity. As Derweesh and Russo note [1], these were complex tumors: 30% were pTlb or higher, and mean RENAL score was 8 (up to 11). With experience, we have learned that large, laterally located, broad-based tumors with significant parenchymal contact surface area result in larger PN defect and increased chance of transfusion (unpubl. data, S. Leslie)