Session: PD07: Kidney Cancer: Localized: Surgical Therapy I
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
Introduction: 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
