PD07-05 ASSESSING THE TRADE-OFF BETWEEN SAFETY AND EFFECTIVENESS OF OFF-CLAMP ROBOTIC PARTIAL NEPHRECTOMY IN PATIENTS WITH HIGH RENAL SCORE: A PROPENSITY SCORE-MATCHED COMPARISON OF PERIOPERATIVE AND FUNCTIONAL OUTCOMES IN A MULTICENTER ANALYSIS

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD07-05 ASSESSING THE TRADE-OFF BETWEEN SAFETY AND EFFECTIVENESS OF OFF-CLAMP ROBOTIC PARTIAL NEPHRECTOMY IN PATIENTS WITH HIGH RENAL SCORE: A PROPENSITY SCORE-MATCHED COMPARISON OF PERIOPERATIVE AND FUNCTIONAL OUTCOMES IN A MULTICENTER ANALYSIS Gabriele Tuderti, Riccardo Mastroianni, Umberto Anceschi, Simone D'Annunzio, Alfredo Maria Bove, Aldo Brassetti, Mariaconsiglia Ferriero, Leonardo Misuraca, Salvatore Guaglianone, Andrea Mari, Ava Saidian, Rekha Narasimhan, Ithaar Derweesh, Riccardo Autorino, Andrea Minervini, Michele Gallucci, and Giuseppe Simone Gabriele TudertiGabriele Tuderti More articles by this author , Riccardo MastroianniRiccardo Mastroianni More articles by this author , Umberto AnceschiUmberto Anceschi More articles by this author , Simone D'AnnunzioSimone D'Annunzio More articles by this author , Alfredo Maria BoveAlfredo Maria Bove More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Leonardo MisuracaLeonardo Misuraca More articles by this author , Salvatore GuaglianoneSalvatore Guaglianone More articles by this author , Andrea MariAndrea Mari More articles by this author , Ava SaidianAva Saidian More articles by this author , Rekha NarasimhanRekha Narasimhan More articles by this author , Ithaar DerweeshIthaar Derweesh More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , Andrea MinerviniAndrea Minervini More articles by this author , Michele GallucciMichele Gallucci More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003231.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The potential functional benefits of Off-clamp (Off-C) robotic partial nephrectomy (RPN) should be considered cautiously, especially in challenging surgical scenarios, such as in high nephrometry score renal tumors. In this multicentric study, we aimed to compare perioperative and functional outcomes of Off-clamp (Off-C) and On-clamp (On-C) RPN in patients with a high RENAL nephrometry score (≥9). METHODS: A RPN dataset including 1604 cases treated at 3 high volume Institutions between 2003 and 2021 was queried for “RENAL score ≥ 9”. A 1:1 propensity score-matched (PSM) analysis was used to minimize imbalances between Off-C and On-C cohorts for age, gender, baseline eGFR, tumor size, diabetes, hypertension, RENAL score, ASA score. Univariable and multivariable regression analysis were performed to identify the predictors of Trifecta achievement (negative margins, no Clavien≥ 3 complications and ≤ 30% eGFR decline) and of maintaining eGFR ≥45 mL/min over time. RESULTS: From 354 patients (142 On-C,212 Off-C), two homogeneous PSM cohorts of 78 patients were selected (p≥0.17). Operative time was significantly lower in the Off-C cohort (p<0.001). No differences in terms of severe complications and positive surgical margins were detected (p=0.32 and p=0.24, respectively). Off-C approach turned into a signicantly higher Trifecta achievement (83.3% vs 67.9%, p=0.03). Prolonging Warm ischemia time (WIT) over 20 mins had an independent detrimental effect on Trifecta achievement (OR=0.32, 95%CI:0.14 –0.74). Moreover, patients receiving Off-C procedure had a significantly higher probability of maintaining an eGFR ≥ 45 mL/min over time (3yr: 95.9%vs81.6%, p=0.03), with every increasing WIT minute reducing this probability by 1.3%. CONCLUSIONS: In expert hands, Off-C RPN provides adequate cancer control, comparable perioperative complications and higher probability of achieving Trifecta. This functional benefit is maintained over time, being the risk of developing eGFR<45 ml/min significantly lower compared with On-C cohort. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e163 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gabriele Tuderti More articles by this author Riccardo Mastroianni More articles by this author Umberto Anceschi More articles by this author Simone D'Annunzio More articles by this author Alfredo Maria Bove More articles by this author Aldo Brassetti More articles by this author Mariaconsiglia Ferriero More articles by this author Leonardo Misuraca More articles by this author Salvatore Guaglianone More articles by this author Andrea Mari More articles by this author Ava Saidian More articles by this author Rekha Narasimhan More articles by this author Ithaar Derweesh More articles by this author Riccardo Autorino More articles by this author Andrea Minervini More articles by this author Michele Gallucci More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF downloadLoading ...