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© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Off-clamp partial nephrectomy represents one of the latest developments in nephron-sparing surgery, with the goal of preserving renal function and reducing ischemia time. The aim of this study was to evaluate and compare the functional, oncologic, and perioperative outcomes between off-clamp robot-assisted partial nephrectomy (off-C RAPN) and off-clamp open partial nephrectomy (off-C OPN) through a propensity score-matched (PSM) analysis. A 1:1 PSM analysis was used to balance variables potentially affecting postoperative outcomes. To report surgical quality, 1 year trifecta was used. Univariable Cox regression analysis was performed to identify predictors of trifecta achievement. The Kaplan–Meier method was used to compare cancer-specific survival (CSS), overall survival (OS), disease-free survival (DFS), and metastasis-free survival (MFS) probabilities between groups. Overall, 542 patients were included. After PSM analysis, two homogeneous cohorts of 147 patients were obtained. The off-C RAPN cohort experienced shorter length of stay (LoS) (3.4 days vs. 5.4 days; p < 0.001), increased likelihoods of achieving 1 year trifecta (89.8% vs. 80.3%; p = 0.03), lower postoperative Clavien–Dindo ≤ 2 complications (1.3% vs. 18.3%, p < 0.001), and lower postoperative transfusion rates (3.4% vs. 12.2%, p = 0.008). At univariable analysis, the surgical approach (off-C RAPN vs. off-C OPN, OR 2.22, 95% CI 1.09–4.46, p = 0.02) was the only predictor of 1 year trifecta achievement. At Kaplan–Meier analysis, no differences were observed between the two groups in terms of OS (log-rank p = 0.451), CSS (log-rank p = 0.476), DFS (log-rank p = 0.678), and MFS (log-rank p = 0.226). Comparing RAPN and OPN in a purely off-clamp scenario, the minimally invasive approach proved to be a feasible and safe surgical approach, with a significantly lower LoS and minor rate of postoperative complications and transfusions as a result of improved surgical quality expressed by higher 1 year trifecta achievement.

Details

Title
Comparison of Perioperative, Functional, and Oncologic Outcomes of Open vs. Robot-Assisted Off-Clamp Partial Nephrectomy: A Propensity Scored Match Analysis
Author
Mastroianni, Riccardo 1   VIAFID ORCID Logo  ; Chiacchio, Giuseppe 2   VIAFID ORCID Logo  ; Perpepaj, Leonard 3 ; Tuderti, Gabriele 1   VIAFID ORCID Logo  ; Brassetti, Aldo 1 ; Anceschi, Umberto 1 ; Ferriero, Mariaconsiglia 1 ; Misuraca, Leonardo 1 ; Simone D’Annunzio 1 ; Bove, Alfredo Maria 1   VIAFID ORCID Logo  ; Guaglianone, Salvatore 1 ; Rocco Simone Flammia 1   VIAFID ORCID Logo  ; Proietti, Flavia 1   VIAFID ORCID Logo  ; Pula, Marco 1 ; Milanese, Giulio 3 ; Costantino Leonardo 1 ; Andrea Benedetto Galosi 3   VIAFID ORCID Logo  ; Simone, Giuseppe 1   VIAFID ORCID Logo 

 Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; [email protected] (R.M.); [email protected] (G.T.); [email protected] (A.B.); [email protected] (U.A.); [email protected] (M.F.); [email protected] (L.M.); [email protected] (S.D.); [email protected] (A.M.B.); [email protected] (S.G.); [email protected] (R.S.F.); [email protected] (F.P.); [email protected] (M.P.); [email protected] (C.L.); [email protected] (G.S.) 
 Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; [email protected] (R.M.); [email protected] (G.T.); [email protected] (A.B.); [email protected] (U.A.); [email protected] (M.F.); [email protected] (L.M.); [email protected] (S.D.); [email protected] (A.M.B.); [email protected] (S.G.); [email protected] (R.S.F.); [email protected] (F.P.); [email protected] (M.P.); [email protected] (C.L.); [email protected] (G.S.); Urology Division, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, 60126 Ancona, Italy; [email protected] (L.P.); [email protected] (G.M.); [email protected] (A.B.G.) 
 Urology Division, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, 60126 Ancona, Italy; [email protected] (L.P.); [email protected] (G.M.); [email protected] (A.B.G.) 
First page
2822
Publication year
2024
Publication date
2024
Publisher
MDPI AG
e-ISSN
14248220
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
3053214136
Copyright
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.