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Tytuł:
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Selective arterial clamping does not improve outcomes in robot-assisted partial nephrectomy: a propensity-score analysis of patients without impaired renal function.
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Autorzy:
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Paulucci DJ; Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
Rosen DC; Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
Sfakianos JP; Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
Whalen MJ; Department of Urology, Yale New Haven Hospital, New Haven, CT, USA.
Abaza R; Robotic Urologic Surgery, OhioHealth Dublin Methodist Hospital, Columbus, OH, USA.
Eun DD; Temple University School of Medicine, Philadelphia, PA, USA.
Krane LS; Wake Forest School of Medicine, Winston-Salem, NC, USA.
Hemal AK; Wake Forest School of Medicine, Winston-Salem, NC, USA.
Badani KK; Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA.
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Źródło:
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BJU international [BJU Int] 2017 Mar; Vol. 119 (3), pp. 430-435. Date of Electronic Publication: 2016 Aug 31.
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Typ publikacji:
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Journal Article; Multicenter Study
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Język:
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English
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Imprint Name(s):
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Original Publication: Oxford, UK : Blackwell Science, c1999-
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MeSH Terms:
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Propensity Score*
Renal Artery*
Robotic Surgical Procedures*
Kidney Neoplasms/*surgery
Nephrectomy/*methods
Aged ; Constriction ; Female ; Humans ; Male ; Middle Aged ; Renal Insufficiency, Chronic ; Retrospective Studies ; Treatment Outcome
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Contributed Indexing:
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Keywords: kidney cancer; nephrectomy; robot-assisted surgical procedure; selective arterial clamping; warm ischaemia time
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Entry Date(s):
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Date Created: 20160803 Date Completed: 20170608 Latest Revision: 20180305
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Update Code:
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20240104
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DOI:
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10.1111/bju.13614
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PMID:
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27480607
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Objectives: To assess the benefit of selective arterial clamping (SAC) as an alternative to main renal artery clamping (MAC) during robot-assisted partial nephrectomy (RAPN) in patients without underlying chronic kidney disease (CKD).
Patients and Methods: Our study cohort comprised 665 patients without impaired renal function undergoing MAC (n = 589) or SAC (n = 76) during RAPN from four medical institutions in the period 2008-2015. We compared complication rates, positive surgical margin (PSM) rates, and peri-operative and intermediate-term renal functional outcome between 132 patients undergoing MAC and 66 undergoing SAC after 2-to-1 nearest-neighbour propensity-score matching for age, sex, body mass index, RENAL nephrometry score, tumour size, baseline estimated glomerular filtration rate (eGFR), American Society of Anesthesiologists (ASA) score, Charlson comorbidity index (CCI) and warm ischaemia time (WIT).
Results: In propensity-score-matched patients, PSM (5.7 vs 3.0%; P = 0.407) and complication rates (13.8 vs 10.6%; P = 0.727) did not differ between the MAC and SAC groups. The incidence of acute kidney injury for MAC vs SAC (25.0 vs 32.0%; P = 0.315) within the first 30 days was similar. At a median follow-up of 7.5 months, the percentage reduction in eGFR (-9.3 vs -10.4%; P = 0.518) and progression to CKD ≥ stage 3 (7.2 vs 8.5%; P = 0.792) showed no difference.
Conclusions: Our study findings show no difference in PSM rates, complication rates or intermediate-term renal functional outcomes between patients with unimpaired renal function who underwent SAC vs those who underwent MAC. When expected WIT is low, the routine use of SAC may not be necessary. Further studies will need to determine the role of SAC in patients with a solitary kidney or with significantly impaired renal function.
(© 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.)
Comment in: J Urol. 2017 Nov;198(5):963. (PMID: 29059742)
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