Off-clamp vs on-clamp robotic partial nephrectomy: Perioperative, functional and oncological outcomes from a propensity-score matching between two high-volume centers.
Eur J Surg Oncol
; 45(7): 1232-1237, 2019 Jul.
Article
em En
| MEDLINE
| ID: mdl-30553632
ABSTRACT
INTRODUCTION:
Aim of the study was to compare perioperative, functional and oncological outcomes after off-clamp vs on-clamp robotic partial nephrectomy (RPN). MATERIALS ANDMETHODS:
Patients who underwent off-clamp or on-clamp (warm ischemia) RPN were extracted from 2 institutional prospectively-maintained databases. 123 patients who underwent off-clamp RPN at one institution were excluded, so that each institution contributed with unselected patients (institution 1on-clamp RPN vs institution 2off-clamp). 21 propensity-score matching (age, sex, smoking, diabetes, hypertension, ASA score, solitary kidney, preoperative eGFR, tumor size and R.E.N.A.L.score). Perioperative outcomes were compared. A linear mixed model was fitted to eGFR as the outcome regressed on fixed effects for 1) management of clamping (on-clamp/off-clamp), 2) time (at baseline, at discharge, at 12 and 24 months postoperatively), and 3) clamp/time interaction. Survival events were compared between groups.RESULTS:
1983 patients were pooled. After matching, 400 on-clamp vs 200 off-clamp patients were analyzed. No significant differences were found in key perioperative outcomes. The effect of on-clamp on eGFR changed over time. At discharge, groups had similar drop in eGFR. The difference between groups was greatest at 12-months postoperatively, with on-clamp patients showing a deficit of 5â¯ml/min. At 24-months follow-up, this gap shrunk to 2â¯ml/min. There were no significant differences in overall survival (pâ¯=â¯0.1), recurrence (χ2â¯=â¯0.008, pâ¯=â¯0.9), or metastasis free survival (χ2â¯=â¯0.962 pâ¯=â¯0.3). Only one cancer-specific death occurred in off-clamp group.CONCLUSION:
We confirm no significant differences in the perioperative and oncological outcomes between off-clamp and on-clamp RPN. Avoided ischemia benefits renal function within 1-year follow-up after surgery. At longer follow-up, difference with on-clamp is softened.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Procedimentos Cirúrgicos Robóticos
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Taxa de Filtração Glomerular
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Neoplasias Renais
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Nefrectomia
Tipo de estudo:
Prognostic_studies
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Eur J Surg Oncol
Assunto da revista:
NEOPLASIAS
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
Estados Unidos