Partial nephrectomy (PN) is the primary surgical method for renal tumor treatment, typically involving clamping the renal artery during tumor removal, leading to warm ischemia and potential renal function impairment. Off-clamp approaches have been explored to mitigate organ damage, yet few results have emerged about the possible effects on hemoglobin loss. Most evidence comes from retrospective studies using propensity score matching, known to be sensitive to PS model misspecification. The energy balancing weights (EBW) method offers an alternative method to address bias by focusing on balancing all the characteristics of covariate distribution. We aimed to compare on- vs. off-clamp techniques in PN using EB-weighted retrospective patient data. Out of 333 consecutive PNs (275/58 on/off-clamp ratio), the EBW method achieved balanced variables, notably tumor anatomy and staging. No significant differences were observed in the operative endpoints between on- and off-clamp techniques, although off-clamp PNs showed slight reductions in hemoglobin loss and renal function decline, albeit with slightly higher perioperative blood loss. Our findings support previous evidence, indicating comparable surgical outcomes between standard and off-clamp procedures, with the EBW method proving effective in balancing baseline variables in observational studies comparing interventions.
Life (Basel, Switzerland). 2024 Mar 27*** epublish ***
Danilo Lofaro, Daniele Amparore, Anna Perri, Vittoria Rago, Alberto Piana, Vincenzo Zaccone, Michele Morelli, Claudio Bisegna, Paolo Pietro Suraci, Domenico Conforti, Francesco Porpiglia, Michele Di Dio
Department of Mathematics and Computer Science, University of Calabria, 87036 Rende, Italy., Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, 10043 Orbassano, Italy., Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy., Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy., Division of Urology, Department of Surgery, Annunziata Hospital, 87100 Cosenza, Italy., Department of Obstetrics and Gynecology, Annunziata Hospital, 87100 Cosenza, Italy., Unit of Urological Minimally Invasive Robotic Surgery and Renal Transplantation, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, 50134 Florence, Italy., Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, 04100 Latina, Italy., de-Health Lab, Department of Mechanical, Energetic and Management Engineering, University of Calabria, 87036 Rende, Italy.