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Off-Clamp versus On-Clamp Robotic Partial Nephrectomy: A Multicenter Match-Paired Case-Control Study

2017; Karger Publishers; Volume: 99; Issue: 3 Linguagem: Inglês

10.1159/000471772

1423-0399

B. Peyronnet, Z. Khene, Benjamin Pradère, Thomas Seisen, G. Verhoest, A. Masson-Lecomte, Y. Grassano, M. Roumiguié, Jean‐Baptiste Beauval, Hervé Baumert, S. Droupy, N. Doumerc, Jean‐Christophe Bernhard, Christophe Vaessen, F. Bruyère, Alexandre de la Taille, Morgan Rouprêt, Karim Bensalah,

Bladder and Urothelial Cancer Treatments

<b><i>Introduction:</i></b> The aim of this study was to compare the outcomes of on-clamp and off-clamp robotic partial nephrectomy (RPN). <b><i>Materials and Methods:</i></b> The charts of all patients who underwent an RPN at 8 institutions between 2010 and 2014 were retrospectively reviewed. The patients who underwent an off-clamp RPN were matched to on-clamp RPN in a 1-4 fashion according to the following variables: RENAL score, tumor size and surgeon's experience. Pre-, intra-, and postoperative data were compared between both groups. <b><i>Results:</i></b> Among 525 RPN, 26 were performed off-clamp (5%). They were matched to 104 on-clamp RPN. The complications rate (15.5 vs. 7.7%, <i>p</i> = 0.53), major complications rate (4.9 vs. 3.9%; <i>p</i> = 0.82), and transfusions rate (0 vs. 4.9%; <i>p</i> = 0.58) did not differ significantly between the clamped and unclamped groups. Conversely, estimated blood loss was higher in the off-clamp group (266.4 vs. 284.6 mL, <i>p</i> = 0.048) and so was the rate of conversion to radical nephrectomy (0 vs. 7.7%, <i>p</i> = 0.04). Postoperative preservation of renal function was comparable in both groups. <b><i>Conclusion:</i></b> Off-clamp RPN is feasible for a small subgroup of renal tumors without increased risk of postoperative complications but at the cost of higher estimated blood loss and increased risk of conversion to radical nephrectomy.