Comparison of Perioperative, Functional, and Oncologic Outcomes of Open vs. Robot-Assisted Off-Clamp Partial Nephrectomy: A Propensity Scored Match Analysis
Riccardo Mastroianni,
Giuseppe Chiacchio,
Leonard Perpepaj,
Gabriele Tuderti,
Aldo Brassetti,
Umberto Anceschi,
Mariaconsiglia Ferriero,
Leonardo Misuraca,
Simone D’Annunzio,
Alfredo Maria Bove,
Salvatore Guaglianone,
Rocco Simone Flammia,
Flavia Proietti,
Marco Pula,
Giulio Milanese,
Costantino Leonardo,
Andrea Benedetto Galosi,
Giuseppe Simone
Affiliations
Riccardo Mastroianni
Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy
Giuseppe Chiacchio
Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy
Leonard Perpepaj
Urology Division, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, 60126 Ancona, Italy
Gabriele Tuderti
Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy
Aldo Brassetti
Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy
Umberto Anceschi
Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy
Mariaconsiglia Ferriero
Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy
Leonardo Misuraca
Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy
Simone D’Annunzio
Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy
Alfredo Maria Bove
Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy
Salvatore Guaglianone
Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy
Rocco Simone Flammia
Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy
Flavia Proietti
Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy
Marco Pula
Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy
Giulio Milanese
Urology Division, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, 60126 Ancona, Italy
Costantino Leonardo
Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy
Andrea Benedetto Galosi
Urology Division, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, 60126 Ancona, Italy
Giuseppe Simone
Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy
Off-clamp partial nephrectomy represents one of the latest developments in nephron-sparing surgery, with the goal of preserving renal function and reducing ischemia time. The aim of this study was to evaluate and compare the functional, oncologic, and perioperative outcomes between off-clamp robot-assisted partial nephrectomy (off-C RAPN) and off-clamp open partial nephrectomy (off-C OPN) through a propensity score-matched (PSM) analysis. A 1:1 PSM analysis was used to balance variables potentially affecting postoperative outcomes. To report surgical quality, 1 year trifecta was used. Univariable Cox regression analysis was performed to identify predictors of trifecta achievement. The Kaplan–Meier method was used to compare cancer-specific survival (CSS), overall survival (OS), disease-free survival (DFS), and metastasis-free survival (MFS) probabilities between groups. Overall, 542 patients were included. After PSM analysis, two homogeneous cohorts of 147 patients were obtained. The off-C RAPN cohort experienced shorter length of stay (LoS) (3.4 days vs. 5.4 days; p p = 0.03), lower postoperative Clavien–Dindo ≤ 2 complications (1.3% vs. 18.3%, p p = 0.008). At univariable analysis, the surgical approach (off-C RAPN vs. off-C OPN, OR 2.22, 95% CI 1.09–4.46, p = 0.02) was the only predictor of 1 year trifecta achievement. At Kaplan–Meier analysis, no differences were observed between the two groups in terms of OS (log-rank p = 0.451), CSS (log-rank p = 0.476), DFS (log-rank p = 0.678), and MFS (log-rank p = 0.226). Comparing RAPN and OPN in a purely off-clamp scenario, the minimally invasive approach proved to be a feasible and safe surgical approach, with a significantly lower LoS and minor rate of postoperative complications and transfusions as a result of improved surgical quality expressed by higher 1 year trifecta achievement.
