Partial nephrectomy is the preferred treatment option for the management of small renal masses. On-clamp partial nephrectomy is associated with a risk of ischemia and a greater loss of postoperative renal function, while the off-clamp procedure decreases the duration of renal ischemia, leading to better renal function preservation. However, the efficacy of the off- versus on-clamp partial nephrectomy for renal function preservation remains debatable.
To compare perioperative and functional outcomes following off- and on-clamp robot-assisted partial nephrectomy (RAPN).
This study used the prospective multinational collaborative Vattikuti Collective Quality Initiative (VCQI) database for RAPN.
The primary objective of this study was the comparison of perioperative and functional outcomes between patients who underwent off- and on-clamp RAPN. Propensity scores were calculated for age, sex, body mass index (BMI), renal nephrometry score (RNS) and preoperative estimated glomerular filtration rate (eGFR).
Of the 2114 patients, 210 had undergone off-clamp RAPN and others on-clamp procedure. Propensity matching was possible for 205 patients in a 1:1 ratio. After matching, the two groups were comparable for age, sex, BMI, tumor size, multifocality, tumor side, face of tumor, RNS, polar location of the tumor, surgical access, and preoperative hemoglobin, creatinine, and eGFR. There was no difference between the two groups for intraoperative (4.8% vs 5.3%, p = 0.823) and postoperative (11.2% vs 8.3%, p = 0.318) complications. Need for blood transfusion (2.9% vs 0, p = 0.030) and conversion to radical nephrectomy (10.2% vs 1%, p < 0.001) were significantly higher in the off-clamp group. At the last follow-up, there was no difference between the two groups for creatinine and eGFR. The mean fall in eGFR at the last follow-up compared with that at baseline was equivalent between the two groups (-16.0 vs -17.3 ml/min, p = 0.985).
Off-clamp RAPN does not result in better renal functional preservation. Alternatively, it may be associated with increased rates of conversion to radical nephrectomy and need for blood transfusion.
With this multicentric study, we noted that performing robotic partial nephrectomy without clamping the blood supply to the kidney is not associated with better preservation of renal function. However, off-clamp partial nephrectomy is associated with increased rates of conversion to radical nephrectomy and blood transfusion.
European urology oncology. 2023 May 14 [Epub ahead of print]
Gopal Sharma, Milap Shah, Puneet Ahluwalia, Prokar Dasgupta, Benjamin J Challacombe, Mahendra Bhandari, Rajesh Ahlawat, Sudhir Rawal, Nicolo M Buffi, Ananthakrishanan Sivaraman, James R Porter, Craig Rogers, Alexandre Mottrie, Ronney Abaza, Khoon Ho Rha, Daniel Moon, Thyavihally B Yuvaraja, Dipen J Parekh, Umberto Capitanio, Kris K Maes, Francesco Porpiglia, Levent Turkeri, Gagan Gautam
Department of Urologic Oncology and Robotic Surgery, Medanta - the Medicity, Gurugram, India., Department of Urology, Aarogyam Speciality Hospital, Ahmedabad, India., Faculty of Life Sciences and Medicine, King's College, King's Health Partners, London, UK., Guy's and St. Thomas' NHS Foundation Trust, London, UK., Vattikuti Foundation, Detroit, MI, USA., Medanta - The Medicity Hospital, New Delhi, India., Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India., Humanitas Research Hospital, Milan, Italy., Chennai Urology and Robotics Institute, Chennai, India., Swedish Medical Center, Seattle, WA, USA., Henry Ford Hospital, Detroit, MI, USA., ORSI Academy, Melle, Belgium., Central Ohio Urology Group and Mount Carmel Health System Prostate Cancer Program, Columbus, OH, USA., Yonsei University Health System, Seoul, South Korea., Peter MacCallum Hospital, Royal Melbourne Clinical School, Melbourne, University of Melbourne, Australia., Kokilaben Dhirubhai Ambani Hospital, Mumbai, India., University of Miami Health System, Miami, FL, USA., Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy., Center for Robotic and Minimally Invasive Surgery, Hospital Da Luz, Luz Sáude, Portugal., San Luigi Gonzaga Hospital of Orbassano, Turin, Italy., Department of Urology, Acıbadem M.A., Altuzinade Hospital, Aydınlar University, Istanbul, Turkey., Department of Urologic Oncology and Robotic Surgery, Medanta - the Medicity, Gurugram, India. Electronic address: .