TY - JOUR
T1 - On-clamp versus off-clamp partial nephrectomy
T2 - Propensity score-matched comparison of long-term functional outcomes
AU - Simone, Giuseppe
AU - Capitanio, Umberto
AU - Tuderti, Gabriele
AU - Presicce, Fabrizio
AU - Leonardo, Costantino
AU - Ferriero, Mariaconsiglia
AU - Misuraca, Leonardo
AU - Costantini, Manuela
AU - Larcher, Alessandro
AU - Minisola, Francesco
AU - Guaglianone, Salvatore
AU - Anceschi, Umberto
AU - Muttin, Fabio
AU - Nini, Alessandro
AU - Trevisani, Francesco
AU - Montorsi, Francesco
AU - Bertini, Roberto
AU - Gallucci, Michele
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Objectives: To compare long-term functional outcomes of off-clamp or on-clamp partial nephrectomy patients of two high-volume centers with cT1–2/N0 M0 renal tumors and baseline estimated glomerular filtration rate >60 mL/min. Methods: A 3:1 propensity score-matched analysis was used to select two homogeneous cohorts to compare off-clamp versus on-clamp partial nephrectomy. Joinpoint regression analysis was used to compare the 2–8-year probabilities of estimated glomerular filtration rate modifications in both selected cohorts. The Kaplan–Meier method assessed the risk of developing a stage ≥3b chronic kidney disease during follow up. Multivariable analyses aimed to identify predictors of renal function deterioration. Perioperative complications and oncological outcomes were compared. Results: Overall, 1073 patients were included (588 on-clamp and 485 off-clamp). After applying the propensity score-matched analysis, the two cohorts of 157 on-clamp and 472 off-clamp patients did not differ for all covariates, except for warm ischemia time and last estimated glomerular filtration rate. At joinpoint analysis, the off-clamp group showed higher probabilities of maintaining an unmodified estimated glomerular filtration rate (P = 0.02). The probability of developing a stage ≥3b chronic kidney disease was significantly higher (P < 0.001) in the on-clamp cohort. At multivariable analysis, estimated glomerular filtration rate at discharge and off-clamp approach were independent predictors of improved functional outcomes. Perioperative complications were comparable among the two cohorts (P = 0.67). There were not any statistically significant differences in terms of cancer-specific survival (P = 0.26) and overall survival (P = 0.18). Conclusions: Off-clamp partial nephrectomy seems to offer a higher probability of maintaining 100% estimated glomerular filtration rate after surgery. In our cohort, patients undergoing on-clamp partial nephrectomy presented a 7.3-fold increased risk of developing a severe chronic kidney disease during follow up.
AB - Objectives: To compare long-term functional outcomes of off-clamp or on-clamp partial nephrectomy patients of two high-volume centers with cT1–2/N0 M0 renal tumors and baseline estimated glomerular filtration rate >60 mL/min. Methods: A 3:1 propensity score-matched analysis was used to select two homogeneous cohorts to compare off-clamp versus on-clamp partial nephrectomy. Joinpoint regression analysis was used to compare the 2–8-year probabilities of estimated glomerular filtration rate modifications in both selected cohorts. The Kaplan–Meier method assessed the risk of developing a stage ≥3b chronic kidney disease during follow up. Multivariable analyses aimed to identify predictors of renal function deterioration. Perioperative complications and oncological outcomes were compared. Results: Overall, 1073 patients were included (588 on-clamp and 485 off-clamp). After applying the propensity score-matched analysis, the two cohorts of 157 on-clamp and 472 off-clamp patients did not differ for all covariates, except for warm ischemia time and last estimated glomerular filtration rate. At joinpoint analysis, the off-clamp group showed higher probabilities of maintaining an unmodified estimated glomerular filtration rate (P = 0.02). The probability of developing a stage ≥3b chronic kidney disease was significantly higher (P < 0.001) in the on-clamp cohort. At multivariable analysis, estimated glomerular filtration rate at discharge and off-clamp approach were independent predictors of improved functional outcomes. Perioperative complications were comparable among the two cohorts (P = 0.67). There were not any statistically significant differences in terms of cancer-specific survival (P = 0.26) and overall survival (P = 0.18). Conclusions: Off-clamp partial nephrectomy seems to offer a higher probability of maintaining 100% estimated glomerular filtration rate after surgery. In our cohort, patients undergoing on-clamp partial nephrectomy presented a 7.3-fold increased risk of developing a severe chronic kidney disease during follow up.
KW - functional outcomes
KW - off-clamp
KW - on-clamp
KW - partial nephrectomy
KW - propensity score matching
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U2 - 10.1111/iju.14079
DO - 10.1111/iju.14079
M3 - Article
C2 - 31342589
AN - SCOPUS:85069913338
SN - 0919-8172
VL - 26
SP - 985
EP - 991
JO - International Journal of Urology
JF - International Journal of Urology
IS - 10
ER -