Off-clamp versus on-clamp robot-assisted partial nephrectomy: A propensity-matched analysis

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Conference Proceeding

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Eur Urol


Introduction & Objectives: To compare perioperative and functional outcomes following off and on-clamp robot-assisted partial nephrectomy (RAPN).

Materials & Methods: This study used prospective multinational collaborative Vattikuti Collective Quality Initiative (VCQI) database for RAPN. The primary objective of this study was comparison of perioperative and functional outcomes between patients who underwent off-clamp and on-clamp RAPN. Propensity scores were calculated for age, sex, BMI, renal nephrometery score (RNS) and preoperative estimated glomerular function rate (eGFR).

Results: Of the 2,114 patients, 210 had undergone off-clamp RAPN and others on-clamp. Two groups were not comparable at baseline with different ages, tumors, and renal nephrometery scores before matching. Propensity matching was possible for 205 patients in a 1:1 ratio. The two groups were comparable for age, sex, BMI, tumor size, multifocality, tumor side, the face of tumor, RNS, polar location of the tumor, surgical access and preoperative hemoglobin, creatinine and eGFR post matching. There was no difference between two groups for intraoperative (4.8% vs. 5.3%, p=0.823) and postoperative complications (11.2% vs. 8.3%, p=0.318). Need for blood transfusion (2.92% vs. 0, p=0.030) and conversion to radical nephrectomy (10.2% vs. 1%, p<0.0001) were significantly higher in off-clamp group. At the last follow-up, there was no difference between the two groups for creatinine and eGFR. Mean fall in eGFR at last follow-up compared to baseline was comparable between the two groups (-16.03 ml/min vs. -17.3 ml/min, p=0.985).

Conclusions: Off-clamp RAPN doesn't result in better renal functional preservation, albeit its associated with increased rates of conversion to radical nephrectomy and blood transfusion.



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