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Off-clamp robot-assisted partial nephrectomy does not benefit short-term renal function: a matched cohort analysis.

Barrett G Anderson1, Aaron M Potretzke2, Kefu Du3

  • 1Division of Urologic Surgery, Washington University School of Medicine, 4960 Children's Place, Campus Box 8242, St. Louis, MO, 63110, USA. bganders@msu.edu.

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PubMed
Summary

Off-clamp robot-assisted partial nephrectomy (RAPN) did not improve renal function preservation compared to clamped RAPN. However, the off-clamp approach showed reduced operative time, blood loss, and complications in this study.

Keywords:
Off-clampPartial nephrectomyRenal cancerRenal surgeryRenal warm ischemiaRobotic surgeryWarm ischemia time

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Area of Science:

  • Urology
  • Nephrology
  • Surgical Oncology

Background:

  • Partial nephrectomy is preferred for T1 renal masses to preserve renal function.
  • Renal warm ischemia, induced by clamping hilar vessels, is a common part of partial nephrectomy.
  • Off-clamp robot-assisted partial nephrectomy (RAPN) is a technique aiming to avoid ischemia-related functional loss.

Purpose of the Study:

  • To compare perioperative and renal functional outcomes of off-clamp RAPN versus clamped RAPN.
  • To evaluate the efficacy of the off-clamp technique in preserving renal function.

Main Methods:

  • Retrospective comparison of patients undergoing RAPN from 2009-2015.
  • Fifty off-clamp RAPN patients were propensity score matched with fifty clamped RAPN patients.
  • Matching criteria included renal function, tumor size, and R.E.N.A.L. nephrometry score.

Main Results:

  • Off-clamp RAPN showed shorter operative times (172.0 vs 196.0 min) and lower estimated blood loss (179.7 vs 283.2 mL) compared to clamped RAPN.
  • Complication rates were lower in the off-clamp group (6.0% vs 20.0%), approaching statistical significance (p=0.071).
  • No significant difference in the decrease of estimated glomerular filtration rate (eGFR) was observed between the two groups at median follow-up (11.9% vs 9.8%).

Conclusions:

  • Off-clamp RAPN did not demonstrate improved renal functional preservation in this institutional experience.
  • The off-clamp technique was associated with reduced operative time, blood loss, and a trend towards fewer complications.
  • Further investigation is warranted to fully elucidate the benefits and limitations of off-clamp RAPN.