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 journalArticlepeer-review

13 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 languageEnglish
Article number4431
JournalCancers
Volume14
Issue number18
DOIs
Publication statusPublished - Sept 2022

Keywords

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

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