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Off-clamp Versus On-clamp Robot-assisted Partial Nephrectomy: A Propensity-matched Analysis.

Gopal Sharma1, Milap Shah2, Puneet Ahluwalia1

  • 1Department of Urologic Oncology and Robotic Surgery, Medanta - the Medicity, Gurugram, India.

European Urology Oncology
|May 16, 2023
PubMed

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Summary

Off-clamp robot-assisted partial nephrectomy (RAPN) does not improve renal function preservation compared to the on-clamp technique. This method may increase the need for blood transfusions and conversion to radical nephrectomy.

Area of Science:

  • Urology
  • Nephrology
  • Surgical Oncology

Background:

  • Partial nephrectomy is the standard treatment for small renal masses.
  • On-clamp partial nephrectomy risks renal function loss due to ischemia.
  • Off-clamp partial nephrectomy aims to minimize ischemia for better renal function preservation, but its efficacy is debated.

Purpose of the Study:

  • To compare perioperative and functional outcomes of off-clamp versus on-clamp robot-assisted partial nephrectomy (RAPN).
  • To evaluate the impact of clamping strategy on renal function preservation after RAPN.

Main Methods:

  • Prospective data from the Vattikuti Collective Quality Initiative (VCQI) database for RAPN.
  • Propensity score matching was used to compare outcomes between off-clamp and on-clamp RAPN groups.
Keywords:
Partial nephrectomyPropensity matchingRoboticoff clamp

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  • Key outcomes included intraoperative and postoperative complications, need for blood transfusion, conversion to radical nephrectomy, and changes in estimated glomerular filtration rate (eGFR).

    • Main Results:

    • After propensity matching, 205 patients (102 off-clamp, 103 on-clamp) were analyzed.
    • No significant differences were observed in intraoperative or postoperative complications between the groups.
    • The off-clamp group showed significantly higher rates of blood transfusion (2.9% vs 0%) and conversion to radical nephrectomy (10.2% vs 1%).
    • Renal function, assessed by creatinine and eGFR, showed no significant difference between the groups at the last follow-up, with equivalent mean eGFR decline.

    Conclusions:

    • Off-clamp RAPN does not offer superior renal functional preservation compared to the on-clamp technique.
    • The off-clamp approach is associated with an increased risk of blood transfusion and conversion to radical nephrectomy.
    • The study suggests that the benefits of off-clamp RAPN in renal function preservation are not evident in this large, multinational cohort.