CLAMP VS CLAMPLESS ENDOSCOPIC ROBOT-ASSISTED SIMPLE ENUCLEATION (ERASE) FOR THE TREATMENT OF CLINICAL T1 RENAL MASSES: ANALYSIS OF SURGICAL AND FUNCTIONAL OUTCOMES FROM A MATCHED-PAIRED COMPARISON.

Scopo del lavoro The potential negative impact of ischemia on renal function (RF) led to an increasing interest to avoid renal clamping. The Scopo del lavoro was to compare the perioperative and functional outcomes of patients who underwent clamped and clampless ERASE in a high-volume centre Materiali e metodi A matched-pair comparison of 120 clamp vs 120 clampless over 350 patients treated with ERASE was performed matching for side, polar tumor location, clinical size score, urinary collecting system and renal sinus dislocation. Perioperative and functional outcomes were compared between groups. Renal function was calculated using biochemical markers (Sr Creatinine, eGFR using MDRD and chronic kidney disease (CKD) stage according to eGFR). Risultati The groups were comparable for demographic, clinical and nephrometry tumor features. Clinical T1a tumors were 107 (89.2%) and 108 (90%), median PADUA score was 7.0 (6.0-7.5) and 7.0 (6.0-8.0) in the clamp and clampless group, respectively. Preoperative CKD stage 1, 2, 3A, 3B and 4 were identified in 50.0%, 39.2%, 5.0%, 3.3%, 2.5% of clamp ERASE vs in 46.7%, 44.2%, 5.0%, 2.5, 1.7% of clampless ERASE. Warm ischemia time was > 20 and >25 minutes in 11.6% and 5.0% of clamp cases. Median intraoperative time was significantly higher in clamp cases (150 vs 120; p<0.0001). No intraoperative complications were registered in both groups. Overall, Clavien 2 and 3 surgical complications were 2.5%, 0.8% and 1.7% vs 3.3%, 2.5% and 0.8% clamp and clampless ERASEs. Surgical margins were registered in 1.7% of each group. Median delta preoperative- 1st postoperative day (POD) and preoperative - 30th POD eGFR was 5.5 (0-15.6) and 8.9 (2.5-19.7) in clamp ERASE vs 1.1 (0-8.5) and 3.2 (0-8.2) clampless ERASE (p=0.01 and p<0.0001, respectively). Preoperative- 30th POD Delta CKD stage was 0 in 82.5% and 91.7%, +1 in 15.0% and 8.3%, +2 2.5% and 0% of clamp and clampless ERASEs, respectively (p=0.01). Discussione Clampless ERASE had comparable postoperative outcomes and provided a significantly lower rate of early CKD development compared to clamp procedures. Conclusioni In our experience, clampless ERASE is a feasible and safe surgical technique.