Purely Off-clamp Robotic Partial Nephrectomy: Preliminary 3-year Oncologic and Functional Outcomes
Objective
The negative impact of ischemia on renal function (RF) has led surgeons to develop minimally ischemic
techniques to perform partial nephrectomy (PN). We described our surgical technique and report perioperative, 3-yr oncologic and functional outcomes of a single centre series of 308 consecutive patients treated with robotic off-clamp PN (OFF-RPN).
Materials and Methods
A prospective renal cancer database was queried and data of all patients treated with OFF-RPN between 2010 and 2015 in a high-volume centre were collected.
Patients were placed in an extended flank position and a 5-port access with a side docking was performed. Hilar vessels were not clamped in any case; pure tumour enucleation or enucleoresection were the resection techniques used; renorraphy was omitted for small and exophytic masses and minimized with a point specific haemostasis†for hilar tumours.
Perioperative complications, 3-yr oncologic and functional outcomes were reported. Univariable and multivariable analyses were performed to identify independent predictors of RF deterioration.
Results
Out of 308 patients treated, 41 (13.3%) experienced perioperative complications, 2.9% of which were Clavien grade 3. Three-yr local recurrence free survival and renal cell carcinoma specific survival rates were 99.5% and 97.9%, respectively (Figure 1).
No patient with preoperative CKD-stage 3B developed severe RF deterioration (CKD-stage 4) at 1-yr follow-up (Figure2).
At multivariable analysis, preoperative eGFR (p=0.005) was the only independent predictor of a new onset CKD-stage 3 in patients with preoperative CKD-stages 1 or 2.
Conclusion
OFF-RPN is a safe surgical approach in tertiary referral centres, with adequate oncological outcomes and negligible impact on RF.
Reference
-Indications, techniques, outcomes, and limitations for minimally ischemic and off-clamp partial nephrectomy: a systematic review of the literature.
Simone G, Gill IS, Mottrie A, Kutikov A, Patard JJ, Alcaraz A, Rogers CG.
Eur Urol. 2015 Oct;68(4):632-40. doi: 10.1016/j.eururo.2015.04.020. Review