MP50-11 HEAD TO HEAD COMPARISON BETWEEN OFF-CLAMP VS ON-CLAMP RAPN IN HIGH-RISK RENAL SCORE KIDNEY TUMORS (2022)

You have accessJournal of UrologyCME1 May 2022MP50-11 HEAD TO HEAD COMPARISON BETWEEN OFF-CLAMP VS ON-CLAMP RAPN IN HIGH-RISK RENAL SCORE KIDNEY TUMORS Rocco Simone Flammia, Umberto Anceschi, Antonio Tufano, Gabriele Tuderti, Alexander Kutikov, Robert G. Uzzo, Francesco Porpiglia, Cristian Fiori, Andrea Minervini, Umberto Capitanio, Riccardo Autorino, Michele Gallucci, Costantino Leonardo, and Giuseppe Simone Rocco Simone FlammiaRocco Simone Flammia More articles by this author , Umberto AnceschiUmberto Anceschi More articles by this author , Antonio TufanoAntonio Tufano More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Robert G. UzzoRobert G. Uzzo More articles by this author , Francesco PorpigliaFrancesco Porpiglia More articles by this author , Cristian FioriCristian Fiori More articles by this author , Andrea MinerviniAndrea Minervini More articles by this author , Umberto CapitanioUmberto Capitanio More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , Michele GallucciMichele Gallucci More articles by this author , Costantino LeonardoCostantino Leonardo More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002625.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The CLOCK trial found no differences between on clamp vs off-clamp RAPN. However, investigators relied mostly on cT1 patients with RENAL score ≤ 10. In consequence, their results are not applicable to more complex and larger renal masses. To address this void we tested the association of off-clamp vs on-clamp RAPN with perioperative and functional outcome within a selective cohort of kidney tumor with high-risk RENAL score. METHODS: Within a multi-institutional database (2012-2019), we identified 116 patients treated with RAPN for kidney tumor harboring RENAL score ≥ 10. Multivariable logistic regression models addressing trifecta achievement, linear regression model addressing postoperative eGFR and Cox regression models and Kaplan-Meier plots addressing any upstaging to CKD ≥ 3a (CKD-upstaging) were applied according to off-clamp vs on-clamp RAPN. Covariates were preoperative eGFR, ASA, age, clinical tumor size and preoperative Hb. Trifecta was defined as the absence of any major complication plus negative surgical margin plus absence of postoperative AKI. RESULTS: Baseline characteristic are reported in Table 1. Overall 55 vs 66 patients were treated with off-clamp vs on-clamp RAPN, respectively. Off-clamp RAPN patients exhibited higher rate of trifecta achievement, that translated into a multivariable OR of 2.78 (1.25-6.46, p=0.014). Moreover, off-clamp RAPN were associated with higher postoperative eGFR at last follow up (linear coefficient +9.8, 95%CI 3.2-16.3, p=0.004). Kaplan-Meier plots depicted 3-years CKD-upstaging-free survival rates of 91% for off-clamp RAPN vs 60% for on-clamp RAPN, which translated in a protective multivariable HR of 0.23 (95%CI 0.08-0.63, p=0.005) in favor of off-clamp RAPN. CONCLUSIONS: In patients treated for high-risk RENAL score kidney tumors, off-clamp RAPN is associated with better perioperative and mid-term functional outcome than their on-clamp counterparts. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e869 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rocco Simone Flammia More articles by this author Umberto Anceschi More articles by this author Antonio Tufano More articles by this author Gabriele Tuderti More articles by this author Alexander Kutikov More articles by this author Robert G. Uzzo More articles by this author Francesco Porpiglia More articles by this author Cristian Fiori More articles by this author Andrea Minervini More articles by this author Umberto Capitanio More articles by this author Riccardo Autorino More articles by this author Michele Gallucci More articles by this author Costantino Leonardo More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF downloadLoading ...