MP75-04 OFF-CLAMP TECHNIQUE OFFERS IMPROVED RENAL FUNCTION OUTCOMES AFTER ROBOTIC PARTIAL NEPHRECTOMY IN LOW AND INTERMEDIATE COMPLEXITY TUMORS

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy V1 Apr 2016MP75-04 OFF-CLAMP TECHNIQUE OFFERS IMPROVED RENAL FUNCTION OUTCOMES AFTER ROBOTIC PARTIAL NEPHRECTOMY IN LOW AND INTERMEDIATE COMPLEXITY TUMORS Daniel C. Rosen, David J. Paulucci, Ronney Abaza, Daniel D. Eun, Ashok K. Hemal, Louis S. Krane, and Ketan K. Badani Daniel C. RosenDaniel C. Rosen More articles by this author , David J. PaulucciDavid J. Paulucci More articles by this author , Ronney AbazaRonney Abaza More articles by this author , Daniel D. EunDaniel D. Eun More articles by this author , Ashok K. HemalAshok K. Hemal More articles by this author , Louis S. KraneLouis S. Krane More articles by this author , and Ketan K. BadaniKetan K. Badani More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1722AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Several arterial clamping techniques have been reported to reduce the deleterious effects of warm ischemia time (WIT) on renal function following partial nephrectomy (PN). Since there is a paucity of comparative data on each technique, the present study compared renal function and surgical outcomes between selective arterial (SAC), main artery (MAC), and off-clamp (OC) techniques in patients undergoing robotic PN (RPN) with low and intermediate complexity tumors. METHODS The present study identified 1,145 patients from 4 medical institutions who underwent RPN from January 2008 to June 2015. Patients with two kidneys, a RENAL score < 10, follow up > 3 months, and a tumor not abutting the main renal artery or vein were included for analysis providing 346 (78.3%) MAC, 37 (8.4%) SAC and 59 (13.3%) OC patients. The percentage change in eGFR was compared between groups using an analysis of covariance. Positive surgical margins (PSM), estimated blood loss (EBL), length of stay (LOS), complications and non-neoplastic parenchymal volume (NNPV) removed were also compared. RESULTS R.E.N.A.L. score (5.8 vs. 6.9 vs. 6.5, p=.001), tumor size (2.2 cm vs. 2.9 vs. 3.1, p<.001) and median follow-up (15.9 months vs. 6 vs. 14.6, p=.002) differed between OC vs. SAC vs. MAC RPN patients respectively. The percentage reduction in eGFR at 13.9 months was significantly lower in OC vs. SAC or MAC RPN (2.5% vs. -7.0 % vs. -9.9%, p=.001) adjusting for R.E.N.A.L. score, American Society of Anesthesiologists score (ASA), body mass index (BMI) and baseline eGFR (Figure 1). In a multivariable cox proportional hazards model, the risk of CKD upstaging was not different in patients undergoing OC vs SAC or MAC (HR= 0.51, p=.260). A trend towards greater EBL (178.0 cc vs. 130.3 vs. 117.1, p=.051) was seen in OC vs. SAC RPN. There were no differences in NNPV removed (p=.586), PSM (p=.849) or complications (p=.693). CONCLUSIONS This study suggests that there may be a renal function advantage to OC RPN. No difference in NNPV removed between groups suggests that the lack of ischemic damage underlies the renal function benefit of OC RPN. Improved renal function without increased risk of PSM or complications suggests that when technically feasible, OC RPN is a consideration in patients with low and intermediate complexity tumors. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e979-e980 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Daniel C. Rosen More articles by this author David J. Paulucci More articles by this author Ronney Abaza More articles by this author Daniel D. Eun More articles by this author Ashok K. Hemal More articles by this author Louis S. Krane More articles by this author Ketan K. Badani More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...