MP49-18 OFF-CLAMP ROBOT-ASSISTED PARTIAL NEPHRECTOMY: HOW FAR SHALL WE PROCEED? (2017)

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy II1 Apr 2017MP49-18 OFF-CLAMP ROBOT-ASSISTED PARTIAL NEPHRECTOMY: HOW FAR SHALL WE PROCEED? Ali Abdel Raheem, Glen Denmer Santok, Lawrence HC Kim, Kidon Chang, Trenton GH Lum, Young Eun Yoon, Woong Kyu Han, Young Deuk Choi, and Koon Ho Rha Ali Abdel RaheemAli Abdel Raheem More articles by this author , Glen Denmer SantokGlen Denmer Santok More articles by this author , Lawrence HC KimLawrence HC Kim More articles by this author , Kidon ChangKidon Chang More articles by this author , Trenton GH LumTrenton GH Lum More articles by this author , Young Eun YoonYoung Eun Yoon More articles by this author , Woong Kyu HanWoong Kyu Han More articles by this author , Young Deuk ChoiYoung Deuk Choi More articles by this author , and Koon Ho RhaKoon Ho Rha More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1520AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To describe our off-clamp robot-assisted partial nephrectomy (RAPN) and to evaluate perioperative and functional outcomes stratified by tumor size and PADUA classification. METHODS Retrospective analysis of 62 patients who underwent off-clamp RAPN from September 2006 to January 2016 was performed. Increased estimated blood loss (EBL) was defined as intraoperative bleeding more than the 75th percentile. ROC analysis was used to determine the optimal threshold of tumor size for both increased EBL and chronic kidney disease (CKD) upstaging. Multivariable analysis was used to assess risk factors for increased EBL. RESULTS Mean patients age was 53.5 years and mean tumor size was 2.6 cm. ROC analysis showed that tumor size of 3.2cm and 4cm were cut-off values for increased EBL (AUC=0.82, p<0.001) and CKD upstaging (AUC=0.87, p=0.004), respectively. On multivariable analysis, involvement of the urinary collecting system and tumor size were predictors of increased EBL (p=0.006 and 0.003, respectively). The 3-ys CKD upstaging free progression rate when stratified by tumor size (=4 cm and >4cm) was (97.1% and 51.4%, retrospectively, p<0.001). CONCLUSIONS Off-clamp RAPN can be safely performed in the hands of expert robotic surgeons; however, risk of intraoperative bleeding in order to achieve good functional outcomes must be adequately balanced before surgery for maximal patient's safety. Our findings showed that tumors >3.2cm and those involving the urinary collecting system are associated with risk of increased intraoperative bleeding, while tumors >4cm have increased risk of CKD upstaging despite zero ischemia. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e654-e655 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Ali Abdel Raheem More articles by this author Glen Denmer Santok More articles by this author Lawrence HC Kim More articles by this author Kidon Chang More articles by this author Trenton GH Lum More articles by this author Young Eun Yoon More articles by this author Woong Kyu Han More articles by this author Young Deuk Choi More articles by this author Koon Ho Rha More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...