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MP59-16 SHIFTING FROM PLANNED OFF-CLAMP TO ON-CLAMP APPROACH DURING PARTIAL NEPHRECTOMY: CROSS-ANALYSIS OF TWO RANDOMIZED TRIALS

2021; Lippincott Williams & Wilkins; Volume: 206; Issue: Supplement 3 Linguagem: Inglês

10.1097/ju.0000000000002094.16

1527-3792

Riccardo Bertolo, Pierluigi Bove, Marco Sandri, Luca Cindolo, Filippo Annino, Chiara Cipriani, Costantino Leonardo, Paolo Parma, R. Nucciotti, Angelo Porreca, Mario Falsaperla, Domenico Veneziano, Antonio Celia, Alessandro Veccia, Francesco Sessa, Andrea Mari, Andrea Minervini, Alessandro Antonelli,

Colorectal Cancer Surgical Treatments

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy V (MP59)1 Sep 2021MP59-16 SHIFTING FROM PLANNED OFF-CLAMP TO ON-CLAMP APPROACH DURING PARTIAL NEPHRECTOMY: CROSS-ANALYSIS OF TWO RANDOMIZED TRIALS Riccardo Bertolo, Pierluigi Bove, Marco Sandri, Luca Cindolo, Filippo Annino, Chiara Cipriani, Costantino Leonardo, Paolo Parma, Roberto Nucciotti, Angelo Porreca, Mario Falsaperla, Domenico Veneziano, Antonio Celia, Alessandro Veccia, Francesco Sessa, Andrea Mari, Andrea Minervini, and Alessandro Antonelli Riccardo BertoloRiccardo Bertolo More articles by this author , Pierluigi BovePierluigi Bove More articles by this author , Marco SandriMarco Sandri More articles by this author , Luca CindoloLuca Cindolo More articles by this author , Filippo AnninoFilippo Annino More articles by this author , Chiara CiprianiChiara Cipriani More articles by this author , Costantino LeonardoCostantino Leonardo More articles by this author , Paolo ParmaPaolo Parma More articles by this author , Roberto NucciottiRoberto Nucciotti More articles by this author , Angelo PorrecaAngelo Porreca More articles by this author , Mario FalsaperlaMario Falsaperla More articles by this author , Domenico VenezianoDomenico Veneziano More articles by this author , Antonio CeliaAntonio Celia More articles by this author , Alessandro VecciaAlessandro Veccia More articles by this author , Francesco SessaFrancesco Sessa More articles by this author , Andrea MariAndrea Mari More articles by this author , Andrea MinerviniAndrea Minervini More articles by this author , and Alessandro AntonelliAlessandro Antonelli More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002094.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Outcomes of 2 dedicated randomized controlled trials (RCTs) comparing on-clamp versus off-clamp robot-assisted (RPN) or pure laparoscopic partial nephrectomy (LPN) (CLOCK I and II RCTs, respectively) have been published. Both in the LPN and in the RPN RCTs, shift from planned off-clamp to on-clamp approach occurred in some patients. We performed a cross-analysis between the trials, comparing perioperative outcomes of RPN vs LPN in these specific subgroups of patients. METHODS: For the purpose of the study, patients randomized to off-clamp and who were shifted to on-clamp RPN and LPN were extracted from CLOCK I and II RCTs, respectively (ClinicalTrials.gov NCT02287987). Univariate analysis of baseline data and perioperative outcomes was performed. Multivariable models were used to balance the effect of potential confounders on the results. RESULTS: 69 out of 164 (42.1%) and 41 out of 126 (32.5%) patients were shifted from off-clamp to on-clamp RPN and LPN (p=0.1) and extracted from the CLOCK I and II RCTs. At baseline, cohorts had comparable age, gender, BMI, comorbidities/performance status, hemoglobin, platelets count, PT/PTT, creatinine, eGFR, tumor size and RENAL score. Median tumor size was 3.5 vs 4 cm (IQR 2.7-4.4 vs 2.5-5, RPN vs LPN, respectively, p=0.4) and RENAL score 7 vs 7 (IQR 6-8 vs 5-8, p=0.6). No significant differences were noted as regarding approach (trans- versus retroperitoneal), resection technique as assessed by the SIB score and renorrhaphy technique. During RPN, AirSeal was more likely used (78% vs 2.4%, p 2 complications favored RPN. 5thpostoperative day hemoglobin was higher after LPN (12 g/dl, IQR 10.9-12.8 vs 13 g/dl, IQR 12-13.7, p=0.01) although no significant differences were found in blood loss. No significant differences in renal function and positive surgical margins (4.5% vs 2.6%, p=1) were found. At multivariable analysis, AirSeal and hemostatic agents use mitigated for differences in operative time (p=0.02), suture time (p=0.001), drainage removal day (p<0.001), 5th postoperative day hemoglobin (p=0.002) and length of stay (p=0.01). CONCLUSIONS: Cross-analysis of two RCTs showed that robotics allows for more favorable perioperative outcomes when shifting from a planned off-clamp to an on-clamp approach during partial nephrectomy. Use of AirSeal and hemostatic agents seemed impacting on such differences. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1037-e1037 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Riccardo Bertolo More articles by this author Pierluigi Bove More articles by this author Marco Sandri More articles by this author Luca Cindolo More articles by this author Filippo Annino More articles by this author Chiara Cipriani More articles by this author Costantino Leonardo More articles by this author Paolo Parma More articles by this author Roberto Nucciotti More articles by this author Angelo Porreca More articles by this author Mario Falsaperla More articles by this author Domenico Veneziano More articles by this author Antonio Celia More articles by this author Alessandro Veccia More articles by this author Francesco Sessa More articles by this author Andrea Mari More articles by this author Andrea Minervini More articles by this author Alessandro Antonelli More articles by this author Expand All Advertisement Loading ...