Presentation Authors: Aldo Brassetti*, Rome, Italy, Riccardo Bertolo, Cleveland, OH, Gabriele Tuderti, Rome, Italy, A Bindavi, San Diego, CA, Garisto Juan, Cleveland, OH, Umberto Anceschi, Rome, Italy, Andrea Minervini, Andrea Mari, Florence, Italy, Akbar Ashrafi, Monish Aron, Los Angeles, CA, Ithaar Derweesh, San Diego, CA, Indiana Sundaram CP, Indianapolis, IN, Jihad Koauk, Cleveland, OH, Riccardo Autorino, Virginia, VA, Francesco Porpiglia, Daniele Amparore, Orbassano, Italy, Luigi Schips, Chieti, Italy, KH Rha, Wonju, Korea, Republic of, Michele Gallucci, Rome, Italy, Ithaar Derweesh, San Diego, CA, Giuseppe Simone, Rome, Italy
Introduction: In the present study, we aimed at comparing the on-clamp versus the off-clamp approach in the same setting in terms of perioperative outcomes and achievement of trifecta outcomes.
Methods: The ROSULA database was queried for patients with non-metastatic cT2 renal masses who had undergone RAPN at the participating institutions during the study period (July 2007-September 2017). Baseline demographic, clinical, pathologic and perioperative data were collected. To overcome the inherent limitations of trifecta definition in off-clamp PN populations due to absence of warm ischemia time, the trifecta outcomes were defined endorsing standardized and reproducible variables: negative surgical margins, no severe complications (Clavien Dindo â‰¥ 3), and â‰¤ 30% postoperative eGFR reduction [according to the National Kidney Foundation (NKF) and the US Food and Drug Administration (FDA)].
Results: Overall, 241 patients were included in the analysis. The two groups were comparable for all baseline variables but tumor size and RENAL score: off-clamp cohort patients harbored significantly larger tumors (p < .001), with higher RENAL nephrometry score (p < 0.001; Table 1). The two groups were comparable for incidence of major bleedings (15% vs 12%, p=0.691), positive surgical margins rate (4% vs 7%, p=0.51) and median eGFR reduction (-12% vs -14%; p=0.301). A trend towards a significant lower incidence of severe complications was observed in the off-clamp cohort (4% vs 14.5%, p=0.052).The overall incidence of trifecta outcomes was comparable between Off-clamp and On-clamp cohorts (65% vs 54%, p=0.18); once restricted the analysis to RENAL score â‰¥ 10, patients who received off-clamp RAPN had a significantly higher probability of achieving trifecta outcomes (65% vs 42.4%, p=0.024) (Figure 1).Conclusions: Off-clamp RPN is safe and effective for cT2 renal masses; its benefits are largely due to improved preservation of renal function and become clinically evident in renal masses with high nephrometry scores.
Conclusions: Off-clamp RPN is safe and effective for cT2 renal masses; its benefits are largely due to improved preservation of renal function and become clinically evident in renal masses with high nephrometry scores.