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.
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.
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).
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.
International journal of urology : official journal of the Japanese Urological Association. 2019 Jul 24 [Epub ahead of print]
Giuseppe Simone, Umberto Capitanio, Gabriele Tuderti, Fabrizio Presicce, Costantino Leonardo, Mariaconsiglia Ferriero, Leonardo Misuraca, Manuela Costantini, Alessandro Larcher, Francesco Minisola, Salvatore Guaglianone, Umberto Anceschi, Fabio Muttin, Alessandro Nini, Francesco Trevisani, Francesco Montorsi, Roberto Bertini, Michele Gallucci
Department of Urology, “Regina Elena” National Cancer Institute, Rome, Italy., Department of Urology, Hospital San Raffaele, University Vita Salute, Milan, Italy., Department of Urology, Sapienza University, Rome, Italy.