Cancers (Sep 2022)
On-Clamp vs. Off-Clamp Robot-Assisted Partial Nephrectomy for cT2 Renal Tumors: Retrospective Propensity-Score-Matched Multicenter Outcome Analysis
- Aldo Brassetti,
- Giovanni E. Cacciamani,
- Andrea Mari,
- Juan D. Garisto,
- Riccardo Bertolo,
- Chandru P. Sundaram,
- Ithaar Derweesh,
- Ahmet Bindayi,
- Prokar Dasgupta,
- James Porter,
- Alexander Mottrie,
- Luigi Schips,
- Koon Ho Rah,
- David Y. T. Chen,
- Chao Zhang,
- Kenneth Jacobsohn,
- Umberto Anceschi,
- Alfredo M. Bove,
- Manuela Costantini,
- Mariaconsiglia Ferriero,
- Riccardo Mastroianni,
- Leonardo Misuraca,
- Gabriele Tuderti,
- Alexander Kutikov,
- Wesley M. White,
- Stephen T. Ryan,
- Francesco Porpiglia,
- Jihad Kaouk,
- Andrea Minervini,
- Inderbir Gill,
- Riccardo Autorino,
- Giuseppe Simone
Affiliations
- Aldo Brassetti
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
- Giovanni E. Cacciamani
- USC Institute of Urology and Catherine, Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, CA 90033, USA
- Andrea Mari
- Department of Experimental and Clinical Medicine, Oncologic Minimally Invasive Urology and Andrology Unit, Careggi Hospital, University of Florence, 50134 Florence, Italy
- Juan D. Garisto
- Department of Urology, Cleveland Clinic, Cleveland, OH 44195, USA
- Riccardo Bertolo
- Division of Urology, San Carlo di Nancy Hospital, 00165 Rome, Italy
- Chandru P. Sundaram
- Department of Urology, Indiana University, Indianapolis, IN 47405, USA
- Ithaar Derweesh
- Department of Urology, UCSD Health System, La Jolla, CA 92103, USA
- Ahmet Bindayi
- Department of Urology, UCSD Health System, La Jolla, CA 92103, USA
- Prokar Dasgupta
- MRC Centre for Transplantation, Guy’s Hospital, King’s College, London WC2R 2LS, UK
- James Porter
- Swedish Urology Group, Seattle, WA 98104, USA
- Alexander Mottrie
- Department of Urology, OLV Hospital, 9300 Aalst, Belgium
- Luigi Schips
- Department of Urology, Annunziata Hospital, G. D’Annunzio University, 66100 Chieti, Italy
- Koon Ho Rah
- Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Korea
- David Y. T. Chen
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
- Chao Zhang
- Department of Urology, Changhai Hospital, Shanghai 200433, China
- Kenneth Jacobsohn
- Department of Urology, Medical College Wisconsin, Milwaukee, WA 53226, USA
- Umberto Anceschi
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
- Alfredo M. Bove
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
- Manuela Costantini
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
- Mariaconsiglia Ferriero
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
- Riccardo Mastroianni
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
- Leonardo Misuraca
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
- Gabriele Tuderti
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
- Alexander Kutikov
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
- Wesley M. White
- Department of Urology, University of Tennessee Medical Center, Knoxville, TN 37920, USA
- Stephen T. Ryan
- Department of Urology, UCSD Health System, La Jolla, CA 92103, USA
- Francesco Porpiglia
- Division of Urology, San Luigi Gonzaga Hospital, University of Turin, 10124 Orbassano, Italy
- Jihad Kaouk
- Department of Urology, Cleveland Clinic, Cleveland, OH 44195, USA
- Andrea Minervini
- Department of Experimental and Clinical Medicine, Oncologic Minimally Invasive Urology and Andrology Unit, Careggi Hospital, University of Florence, 50134 Florence, Italy
- Inderbir Gill
- USC Institute of Urology and Catherine, Joseph Aresty Department of Urology, Keck School of Medicine, Los Angeles, CA 90033, USA
- Riccardo Autorino
- Division of Urology, Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA 23298, USA
- Giuseppe Simone
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
- DOI
- https://doi.org/10.3390/cancers14184431
- Journal volume & issue
-
Vol. 14,
no. 18
p. 4431
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 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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