Laparoscopic/ Robotic: Other

Moderated Poster Session

MP16-17 - On-clamp versus Off-clamp Partial Nephrectomy: Propensity Score Matched Comparison of Long Term Functional Outcomes.

Saturday, September 22
10:00 AM - 12:00 PM
Location: Room 243

Introduction & Objective :

To compare renal functional outcomes after either off-clamp (Off-C) or on-clamp (On-C) PN in patients with cT1- 2/N0 M0 renal tumors and baseline estimated eGFR >60 ml/min.


Methods :

A prospective “renal cancer” database of two high volume centers was queried for “cT1-2/N0/M0” tumors and “baseline eGFR>60 mL/min”. Overall 1073 patients met the inclusion criteria, 588 of which underwent On-C PN and 485 Off-C PN. A 1:3 propensity score-matched (PSM) analysis was                 employed to minimize the selection bias of non-random assignment of patients to the two groups.                                                                           Joinpoint regression analysis was used to plot the 2 to 8 yrs probabilities of experiencing eGFR decreases of 0%, < 25% and between 25 and 50% in both PSM cohorts and therefore to compare the trends for each of these 3 subgroups.                                                                                             Kaplan–Meier method was used to compare the risk of developing a CKD stage≥3b (eGFR<45mL/min) during follow-up in the PSM cohorts. Univariable and multivariable Cox regression analyses were performed to identify independent predictors of developing a CKD stage≥3b during follow-up. 


 


Results :

In the whole cohort  On-C patients were significantly younger (p=0.001), less frequently smokers (p=0.01), with a lower incidence of diabetes (p=0.001) and hypertension (p=0.001), lower ASA scores (p<0.001), higher baseline eGFR values (p=0.003), smaller tumor sizes (p<0.001), longer warm ischemia time (17 minutes vs 0, p<0.001) and higher incidence of positive surgical margins (p=0.021). After applying the PSM analysis, the two cohorts of 157 On-C and 471 Off-C PN cases did not differ for all clinical and pathologic covariates (Table 1;all ≥0.08), except for mean warm ischemia time (p<0.001).
At Joinpoint regression analysis Off-C group displayed significantly higher probabilities of maintaining unmodified eGFR after surgery (p=0.02), and significantly lower probabilities of experiencing eGFR decrease >25% in the first 8-yr follow-up (p=0.02) The probability of developing a CKD stage ≥3b was significantly higher (log rank p=0.006) in the On-C cohort (2, 5 and 8yr risk 0.9%, 5.1% and 12.8% versus 0.6%, 1.2% and 1.2% in the Off-C cohort, respectively.                                                                                                                                                                                                                At multivariable Cox regression analysis, eGFR at discharge (HR 0.94 [95% CIs 0.91–0.98]; p=0.002) and Off-clamp approach (HR .33 [95% CIs 1.8-29.4]; p=0.005) were independent predictors of improved renal functional outcomes.


Conclusions :

Off-C PN is associated with a significantly higher probability of maintaining 100% eGFR after surgery compared with On-C PN in patients with cT1-2/N0/MO renal tumors and good baseline renal function candidate to elective PN. 

Gabriele Tuderti

Fellow
"Regina Elena" National Cancer Institute, Dept. of Urology

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    Giuseppe Simone

    Consultant
    “Regina Elena” National Cancer Institute, Dept. of Urology

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      Umberto Capitanio

      Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy

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        Alessandro Larcher

        Hospital San Raffaele, University Vita Salute, Department of Urology

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          Mariaconsiglia Ferriero

          MD, PhD
          "Regina Elena" National Cancer Institute, Dept. of Urology

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            Leonardo Misuraca

            Fellow
            "Regina Elena" National Cancer Institute, Dept. of Urology

            MD, Fellow of the European Board of Urology, Consultant Urologist ASL TO4, Turin (Italy)

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              Manuela Costantini

              "Regina Elena” National Cancer Institute, Dept. of Urology

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                Francesco Minisola

                "Regina Elena" National Cancer Institute, Dept. of Urology

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                  Salvatore Guaglianone

                  "Regina Elena" National Cancer Institute, Dept. of Urology

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                    Fabio Muttin

                    "Hospital San Raffaele, University Vita Salute, Department of Urology

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                      Alessandro Nini

                      Hospital San Raffaele, University Vita Salute, Department of Urology

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                        Francesco Trevisani

                        Hospital San Raffaele, University Vita Salute, Department of Urology

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                          Francesco Montorsi

                          Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy

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                            Roberto Bertini

                            Hospital San Raffaele, University Vita Salute, Department of Urology

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                              Michele Gallucci

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