We compared perioperative outcomes after on-clamp versus off-clamp robot-assisted partial nephrectomy (RAPN) for >7 cm renal masses. A multicenter dataset was queried for patients who had undergone RAPN for a cT2cN0cM0 kidney tumor from July 2007 to February 2022. The Trifecta achievement (negative surgical margins, no severe complications, and ≤ 30% postoperative estimated glomerular filtration rate (eGFR) reduction) was considered a surrogate of surgical quality. Overall, 316 cases were included in the analysis, and 58% achieved the Trifecta. A propensity-score-matched analysis generated two cohorts of 89 patients homogeneous for age, ASA score, preoperative eGFR, and RENAL score (all p > 0.21). Compared to the on-clamp approach, OT was significantly shorter in the off-clamp group (80 vs. 190 min; p < 0.001), the incidence of sRFD was lower (22% vs. 40%; p = 0.01), and the Trifecta rate higher (66% vs. 46%; p = 0.01). In a crude analysis, >20 min of hilar clamping was associated with a significantly higher risk of sRFD (OR: 2.30; 95%CI: 1.13-4.64; p = 0.02) and with reduced probabilities of achieving the Trifecta (OR: 0.46; 95%CI: 0.27-0.79; p = 0.004). Purely off-clamp RAPN seems to be a safe and viable option to treat cT2 renal masses and may outperform the on-clamp approach regarding perioperative surgical outcomes.

On-Clamp vs. Off-Clamp Robot-Assisted Partial Nephrectomy for cT2 Renal Tumors: Retrospective Propensity-Score-Matched Multicenter Outcome Analysis / Brassetti, Aldo; Cacciamani, Giovanni E; Mari, Andrea; Garisto, Juan D; Bertolo, Riccardo; Sundaram, Chandru P; Derweesh, Ithaar; Bindayi, Ahmet; Dasgupta, Prokar; Porter, James; Mottrie, Alexander; Schips, Luigi; Rah, Koon Ho; Chen, David Y T; Zhang, Chao; Jacobsohn, Kenneth; Anceschi, Umberto; Bove, Alfredo M; Costantini, Manuela; Ferriero, Mariaconsiglia; Mastroianni, Riccardo; Misuraca, Leonardo; Tuderti, Gabriele; Kutikov, Alexander; White, Wesley M; Ryan, Stephen T; Porpiglia, Francesco; Kaouk, Jihad; Minervini, Andrea; Gill, Inderbir; Autorino, Riccardo; Simone, Giuseppe. - In: CANCERS. - ISSN 2072-6694. - ELETTRONICO. - 14:(2022), pp. 0-0. [10.3390/cancers14184431]

On-Clamp vs. Off-Clamp Robot-Assisted Partial Nephrectomy for cT2 Renal Tumors: Retrospective Propensity-Score-Matched Multicenter Outcome Analysis

Mari, Andrea
Membro del Collaboration Group
;
Minervini, Andrea
Membro del Collaboration Group
;
2022

Abstract

We compared perioperative outcomes after on-clamp versus off-clamp robot-assisted partial nephrectomy (RAPN) for >7 cm renal masses. A multicenter dataset was queried for patients who had undergone RAPN for a cT2cN0cM0 kidney tumor from July 2007 to February 2022. The Trifecta achievement (negative surgical margins, no severe complications, and ≤ 30% postoperative estimated glomerular filtration rate (eGFR) reduction) was considered a surrogate of surgical quality. Overall, 316 cases were included in the analysis, and 58% achieved the Trifecta. A propensity-score-matched analysis generated two cohorts of 89 patients homogeneous for age, ASA score, preoperative eGFR, and RENAL score (all p > 0.21). Compared to the on-clamp approach, OT was significantly shorter in the off-clamp group (80 vs. 190 min; p < 0.001), the incidence of sRFD was lower (22% vs. 40%; p = 0.01), and the Trifecta rate higher (66% vs. 46%; p = 0.01). In a crude analysis, >20 min of hilar clamping was associated with a significantly higher risk of sRFD (OR: 2.30; 95%CI: 1.13-4.64; p = 0.02) and with reduced probabilities of achieving the Trifecta (OR: 0.46; 95%CI: 0.27-0.79; p = 0.004). Purely off-clamp RAPN seems to be a safe and viable option to treat cT2 renal masses and may outperform the on-clamp approach regarding perioperative surgical outcomes.
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Brassetti, Aldo; Cacciamani, Giovanni E; Mari, Andrea; Garisto, Juan D; Bertolo, Riccardo; Sundaram, Chandru P; Derweesh, Ithaar; Bindayi, Ahmet; Dasgupta, Prokar; Porter, James; Mottrie, Alexander; Schips, Luigi; Rah, Koon Ho; Chen, David Y T; Zhang, Chao; Jacobsohn, Kenneth; Anceschi, Umberto; Bove, Alfredo M; Costantini, Manuela; Ferriero, Mariaconsiglia; Mastroianni, Riccardo; Misuraca, Leonardo; Tuderti, Gabriele; Kutikov, Alexander; White, Wesley M; Ryan, Stephen T; Porpiglia, Francesco; Kaouk, Jihad; Minervini, Andrea; Gill, Inderbir; Autorino, Riccardo; Simone, Giuseppe
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2158/1287514
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