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

doi:10.3390/cancers14184431

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 FerrieroRiccardo 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

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

26 Citations (Scopus)

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 < 0.001), the incidence of sRFD was lower (22% vs. 40%; 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.

Original language	English
Article number	4431
Journal	Cancers
Volume	14
Issue number	18
DOIs	https://doi.org/10.3390/cancers14184431
Publication status	Published - Sept 2022

Keywords

clinical T2
hilar clamping
off-clamp
on-clamp
outcomes
partial nephrectomy
renal mass
renal neoplasm
robot-assisted

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.3390/cancers14184431

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Brassetti, A., Cacciamani, G. E., Mari, A., Garisto, J. D., Bertolo, R., Sundaram, C. P., Derweesh, I., Bindayi, A., Dasgupta, P., Porter, J., Mottrie, A., Schips, L., Rah, K. H., Chen, D. Y. T., Zhang, C., Jacobsohn, K., Anceschi, U., Bove, A. M., Costantini, M., ... Simone, G. (2022). On-Clamp vs. Off-Clamp Robot-Assisted Partial Nephrectomy for cT2 Renal Tumors: Retrospective Propensity-Score-Matched Multicenter Outcome Analysis. Cancers, 14(18), Article 4431. https://doi.org/10.3390/cancers14184431

@article{a7227584c3614d41a73669bbf21230a4,

title = "On-Clamp vs. Off-Clamp Robot-Assisted Partial Nephrectomy for cT2 Renal Tumors: Retrospective Propensity-Score-Matched Multicenter Outcome Analysis",

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 < 0.001), the incidence of sRFD was lower (22% vs. 40%; 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.",

keywords = "clinical T2, hilar clamping, off-clamp, on-clamp, outcomes, partial nephrectomy, renal mass, renal neoplasm, robot-assisted",

author = "Aldo Brassetti and Cacciamani, {Giovanni E.} and Andrea Mari and Garisto, {Juan D.} and Riccardo Bertolo and Sundaram, {Chandru P.} and Ithaar Derweesh and Ahmet Bindayi and Prokar Dasgupta and James Porter and Alexander Mottrie and Luigi Schips and Rah, {Koon Ho} and Chen, {David Y.T.} and Chao Zhang and Kenneth Jacobsohn and Umberto Anceschi and Bove, {Alfredo M.} and Manuela Costantini and Mariaconsiglia Ferriero and Riccardo Mastroianni and Leonardo Misuraca and Gabriele Tuderti and Alexander Kutikov and White, {Wesley M.} and Ryan, {Stephen T.} and Francesco Porpiglia and Jihad Kaouk and Andrea Minervini and Inderbir Gill and Riccardo Autorino and Giuseppe Simone",

note = "Publisher Copyright: {\textcopyright} 2022 by the authors.",

year = "2022",

month = sep,

doi = "10.3390/cancers14184431",

language = "English",

volume = "14",

journal = "Cancers",

issn = "2072-6694",

publisher = "Multidisciplinary Digital Publishing Institute (MDPI)",

number = "18",

}

Brassetti, A, Cacciamani, GE, Mari, A, Garisto, JD, Bertolo, R, Sundaram, CP, Derweesh, I, Bindayi, A, Dasgupta, P, Porter, J, Mottrie, A, Schips, L, Rah, KH, Chen, DYT, Zhang, C, Jacobsohn, K, Anceschi, U, Bove, AM, Costantini, M, Ferriero, M, Mastroianni, R, Misuraca, L, Tuderti, G, Kutikov, A, White, WM, Ryan, ST, Porpiglia, F, Kaouk, J, Minervini, A, Gill, I, Autorino, R & Simone, G 2022, 'On-Clamp vs. Off-Clamp Robot-Assisted Partial Nephrectomy for cT2 Renal Tumors: Retrospective Propensity-Score-Matched Multicenter Outcome Analysis', Cancers, vol. 14, no. 18, 4431. https://doi.org/10.3390/cancers14184431

TY - JOUR

T1 - On-Clamp vs. Off-Clamp Robot-Assisted Partial Nephrectomy for cT2 Renal Tumors

T2 - Retrospective Propensity-Score-Matched Multicenter Outcome Analysis

AU - Brassetti, Aldo

AU - Cacciamani, Giovanni E.

AU - Mari, Andrea

AU - Garisto, Juan D.

AU - Bertolo, Riccardo

AU - Sundaram, Chandru P.

AU - Derweesh, Ithaar

AU - Bindayi, Ahmet

AU - Dasgupta, Prokar

AU - Porter, James

AU - Mottrie, Alexander

AU - Schips, Luigi

AU - Rah, Koon Ho

AU - Chen, David Y.T.

AU - Zhang, Chao

AU - Jacobsohn, Kenneth

AU - Anceschi, Umberto

AU - Bove, Alfredo M.

AU - Costantini, Manuela

AU - Ferriero, Mariaconsiglia

AU - Mastroianni, Riccardo

AU - Misuraca, Leonardo

AU - Tuderti, Gabriele

AU - Kutikov, Alexander

AU - White, Wesley M.

AU - Ryan, Stephen T.

AU - Porpiglia, Francesco

AU - Kaouk, Jihad

AU - Minervini, Andrea

AU - Gill, Inderbir

AU - Autorino, Riccardo

AU - Simone, Giuseppe

PY - 2022/9

Y1 - 2022/9

N2 - 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 < 0.001), the incidence of sRFD was lower (22% vs. 40%; 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.

AB - 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 < 0.001), the incidence of sRFD was lower (22% vs. 40%; 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.

KW - clinical T2

KW - hilar clamping

KW - off-clamp

KW - on-clamp

KW - outcomes

KW - partial nephrectomy

KW - renal mass

KW - renal neoplasm

KW - robot-assisted

UR - http://www.scopus.com/inward/record.url?scp=85138755202&partnerID=8YFLogxK

U2 - 10.3390/cancers14184431

DO - 10.3390/cancers14184431

M3 - Article

AN - SCOPUS:85138755202

SN - 2072-6694

VL - 14

JO - Cancers

JF - Cancers

IS - 18

M1 - 4431

ER -

On-Clamp vs. Off-Clamp Robot-Assisted Partial Nephrectomy for cT2 Renal Tumors: Retrospective Propensity-Score-Matched Multicenter Outcome Analysis

Abstract

Keywords

UN SDGs

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