On-Clamp versus purely Off-Clamp robotic partial nephrectomy in solitary kidneys: comparison of chronic kidney disease progression at two high-volume centers

Anceschi, Umberto; Bertolo, R.; Brassetti, Aldo; Tuderti, Gabriele; Costantini, M.; Flammia, Rocco Simone; Mastroianni, Riccardo; Ferriero, Mariaconsiglia; Bove, Alfredo Maria; Guaglianone, Salvatore; Gallucci, M.; Kaouk, Jihad; Simone, G.

doi:10.1016/s2666-1683(20)35522-1

Cited by 1 publication

(6 citation statements)

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“…Notwithstanding several limitations of our study, we reported the latest and largest meta-analysis that added six novel articles (four cohort studies ( 24 , 25 , 27 , 29 ) and two prospective randomized studies ( 26 , 28 ) published during 2019–2021 on the bases of previous studies, which makes our evidence more credible. Our evidence-based analysis validated previous studies reporting the superiority of the off-clamp technique in RAPN ( 9 , 10 , 12 , 20 ), especially in patients who require preservation of renal function (e.g., solitary kidney or chronic kidney disease) ( 23 ).…”

Section: Discussionmentioning

confidence: 94%

“…Finally, 21 full-text articles involving 4,493 patients (1,274 off-clamp versus 3,219 on-clamp) were included for the pooled analysis ( 9 – 29 ). Of these articles, 7 were prospective cohort studies ( 9 , 10 , 12 , 13 , 16 , 18 , 25 , 27 ), 10 were retrospective cohort studies ( 11 , 14 , 15 , 17 , 19 – 21 , 23 , 24 , 29 ), and 3 were prospective randomized studies ( 22 , 26 , 28 ). Table 1 shows the characteristics, level of evidence, and quality score of each included study.…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies involving 577 patients (206 off-clamp versus 371 on-clamp) were included in the analysis ( 14 , 15 , 17 , 21 , 22 , 24 , 25 ). Pooled results demonstrated that the rate of conversion to radical or open surgery was similar between the two groups (OR: 1.57; 95% CI: 0.54, 4.60; p = 0.41), and no significant heterogeneity was observed ( I 2 = 0%, p = 0.88) ( Figure 2C ).…”

Section: Resultsmentioning

confidence: 99%

“…Nine articles reported the data of LOS, including 1,573 patients (521 off-clamp versus 1,052 on-clamp) ( 12 , 14 – 16 , 20 , 21 , 23 – 25 ). No significant difference was detected among the two groups (WMD: 0.23; 95% CI: -0.63, 1.08; p = 0.60), but statistically significant heterogeneity was observed ( I 2 = 97%, p < 0.00001) ( Figure 2D ).…”

Section: Resultsmentioning

confidence: 99%

“…Data of recurrence rate were obtained from nine studies with 2,462 patients (576 off-clamp versus 1,886 on-clamp) ( 12 , 13 , 15 , 17 , 20 , 22 , 24 , 25 , 29 ). No significant difference was observed between the two groups for recurrence rate (OR: 0.89; 95% CI: 0.52, 1.54; p = 0.69), and no significant heterogeneity ( I 2 = 0%, p = 0.87) was detected ( Figure 4B ).…”

Section: Resultsmentioning

confidence: 99%

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Comparison of Perioperative, Renal Functional, and Oncological Outcomes Between Off-Clamp and On-Clamp Robot-Assisted Partial Nephrectomy for Renal Tumors: An Updated Evidence-Based Analysis

et al. 2021

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ObjectivesWe aimed to report the latest and largest pooled analysis and evidence update to compare the perioperative, renal functional, and oncological outcomes between off-clamp and on-clamp robot-assisted partial nephrectomy (RAPN) for renal tumors.Patients and methodsWe performed a systematic literature search using PubMed, Embase, and Web of Science up to August 2021 for studies that compared the efficacy and/or safety between off-clamp and on-clamp RAPN for renal tumors. Outcomes measured were operating time, estimated blood loss (EBL), conversion rate, length of stay (LOS), complication rate, transfusion rate, long-term % decrease in estimated glomerular filtration rate (eGFR), positive surgical margin rate, and recurrence rate.ResultsA total of 21 eligible articles involving 4,493 patients (1,274 off-clamp versus 3,219 on-clamp) were included for the evidence synthesis. Baseline characteristics of the two groups were similar in all outcomes except that lower R.E.N.A.L. score and smaller tumor size were observed in the off-clamp group. Pooled analysis showed shorter operative time, higher EBL, and lower complication rate in the off-clamp group. No significant difference was observed in the conversion rate, LOS, and transfusion rate. The recurrence rates were similar in the two groups, while a lower positive surgical margin rate was observed in the off-clamp group. Finally, the off-clamp group had a superior postoperative renal functional outcome.ConclusionsGiven the presence of heterogeneity and potential bias, urologists should select the clamp strategy based on their experience and patient-specific factors.

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