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Is off-clamp robot-assisted partial nephrectomy beneficial for renal function? Data from the CLOCK trial
Alessandro Antonelli1,2, Luca Cindolo3, Marco Sandri4
1Urology Unit ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy.
BJU International
|June 4, 2021
Summary
Robot-assisted partial nephrectomy (RAPN) outcomes were compared between on-clamp and off-clamp techniques. This randomized controlled trial found no significant difference in kidney function between the two RAPN approaches.
Area of Science:
- Urology
- Nephrology
- Surgical Innovation
Background:
- Robot-assisted partial nephrectomy (RAPN) is a minimally invasive technique for kidney tumor removal.
- The impact of clamping the renal artery (on-clamp) versus not clamping it (off-clamp) during RAPN on kidney function is debated.
- Understanding functional outcomes is crucial for optimizing surgical strategies.
Purpose of the Study:
- To compare the functional outcomes of on-clamp versus off-clamp robot-assisted partial nephrectomy (RAPN).
- To evaluate differences in estimated glomerular filtration rate (GFR) and split renal function between the two techniques.
- To provide evidence for surgical decision-making in RAPN.
Main Methods:
- A multicenter randomized controlled trial (CLOCK study) involving patients with normal baseline kidney function and renal masses (RENAL score ≤ 10).
- Patients were randomized to either on-clamp or off-clamp RAPN.
- Primary endpoint was the 6-month absolute variation in estimated GFR (AV-GFR); secondary endpoints included long-term GFR variation and split renal function (AV-SRF).
- Intention-to-treat (ITT) and per-protocol (PP) analyses were performed.
Main Results:
- 160 and 164 patients were randomized to on- and off-clamp RAPN, respectively.
- No statistically significant difference was found in the primary endpoint (6-month AV-GFR) between the on-clamp and off-clamp groups in both ITT and PP analyses.
- Secondary endpoints, including long-term GFR variation and AV-SRF, also showed no significant differences between the groups.
- Median warm ischemia time was 14-15 min for on-clamp and 0 min for off-clamp in PP analysis.
Conclusions:
- In patients with normal baseline kidney function and two kidneys, on-clamp and off-clamp RAPN yield similar functional outcomes.
- There is no evidence to suggest one technique is superior to the other in preserving kidney function postoperatively.
- These findings support the use of either on-clamp or off-clamp RAPN based on surgeon preference and patient-specific factors.
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