ORIGINAL RESEARCH article
Front. Surg.
Sec. Surgical Oncology
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1683222
This article is part of the Research TopicAdvancements and Challenges in Retroperitoneal Approaches for Urological SurgeriesView all 5 articles
Three-Dimensional Reconstruction-Guided Modified Arterial-Based Complexity Scoring System for Nephron-Sparing Surgery: Comparative Outcomes of On-Clamp and Off-Clamp Tumor Enucleation in Renal Cell Carcinoma
Provisionally accepted- 1The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
- 2The Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, China
- 3Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
- 4Zhejiang University School of Medicine, Hangzhou, China
- 5Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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The lack of a comprehensive standard for selecting optimal nephron-sparing surgery (NSS) approaches impedes personalized care for patients with renal cell carcinoma. This study aimed to develop a modified Arterial-Based Complexity (mABC) scoring system that integrates three-dimensional tumor reconstruction to guide the choice between on-clamp and off-clamp (zero-ischemia) tumor enucleation (TE). Regression analysis informed the development of the mABC score (combining CSA and anatomical tumor depth). Our results demonstrated that off-clamp TE reduced ischemia time and better preserved long-term renal function, particularly in patients with pre-existing renal impairment. However, off-clamp TE was associated with increased blood loss, drainage volume, catheterization time, and hospital stay compared to on-clamp TE and partial nephrectomy (PN).The mABC scoring system effectively stratifies surgical complexity. Off-clamp TE optimizes renal function preservation for low-complexity tumors (mABC <4), whereas on-clamp TE is more suitable for high-complexity tumors (mABC ≥4). Trial registration: Our study has been approved by the Ethics Committee of The Fourth Affiliated Hospital of Zhejiang University School of Medicine (K2023003) on 10/02/2023 and by clinical trials (NCT05790122) on 27/03/2023.
Keywords: nephron-sparing surgery, tumor enucleation, Zero ischemia, Modified arterial-based complexity, Renal cell carcinoma
Received: 10 Aug 2025; Accepted: 20 Oct 2025.
Copyright: © 2025 Xu, Jiang, Du, Yang, Zhong, Liu, Zhang and Zheng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Cheng Zhang, zhangcheng13836182568@zju.edu.cn
Yichun Zheng, 2101090@zju.edu.cn
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