Prospective Randomized Comparison of Clamped Versus Unclamped Partial Nephrectomy
PRIMARY OBJECTIVES: I. To compare the changes in renal function (post-operative compared to
pre-operative) in patients undergoing unclamped partial nephrectomy with or without
controlled hypotension (Arm A) vs. those undergoing partial nephrectomy with hilar clamping
(Arm B), as measured by change in estimated glomerular filtration rate (eGFR). SECONDARY
OBJECTIVES: I. To compare the changes in renal function (post-operative compared to
pre-operative) in patients undergoing unclamped partial nephrectomy with or without
controlled hypotension (Arm A) vs. those undergoing partial nephrectomy with hilar clamping
(Arm B), as measured by change in MAG3 (% of function attributed to affected kidney) and
change in serum creatinine. II. To evaluate the safety of the unclamped procedure by
estimating the differences in complication rates in patients undergoing unclamped partial
nephrectomy with or without controlled hypotension (Arm A) vs. patients undergoing partial
nephrectomy with hilar clamping (Arm B) in terms of intra-operative complications and
post-operative complications. III. To evaluate the surgical effectiveness of the unclamped
procedure by estimating the differences between patients undergoing unclamped partial
nephrectomy with or without controlled hypotension (Arm A) vs. patients undergoing partial
nephrectomy with hilar clamping (Arm B) in terms of surgical margin status, estimated blood
loss, and transfusion rate (intraoperative and post-operative). TERTIARY OBJECTIVES: I.
To record and compare the intrarenal blood flow and resistive index measurements in order to
determine if a relationship exists between intraoperative findings and postoperative renal
function. II. To quantify the amount of acute kidney injury (AKI) and compare the
differences between patients undergoing unclamped partial nephrectomy with or without
controlled hypotension (Arm A) vs. patients undergoing partial nephrectomy with hilar
clamping (Arm B) as measured by urinary and serum biomarkers. III. To compare the effects
of the unclamped procedure (Arm A) to the clamped procedure (Arm B) in patients with
baseline eGFR < 60, and in patients with age >= 75 (exploratory subset analyses).
OUTLINE: Patients are randomized to 1 of 2 treatment arms. ARM A: Patients undergo
unclamped partial nephrectomy. Some patients may undergo unclamped partial nephrectomy with
controlled hypotension. ARM B: Patients undergo clamped partial nephrectomy. After
completion of study treatment, patients are followed up at 1 week and then at 1, 3, 6, and
12 months.
Interventional
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Supportive Care
Change from baseline in renal function as measured by eGFR
Measured by eGFR, MAG-3 Nuclear Renal Scan, and serum creatinine. The two arms will be compared using regression methods that will account for repeated measures and the pre-randomization stratification.
Up to 1 year
No
Mihir Desai
Principal Investigator
USC/Norris Comprehensive Cancer Center
United States: Federal Government
4K-10-2
NCT01547676
December 2011
December 2015
Name | Location |
---|---|
USC/Norris Comprehensive Cancer Center | Los Angeles, California 90033-0800 |