Off-clamp Versus On-clamp Robot-assisted Partial Nephrectomy: A Systematic Review and Quantitative Synthesis by the European Association of Urology Young Academic Urologists Renal Cancer Study Group
Context: The superiority of off-clamp robot-assisted partial nephrectomy (RAPN) over the on-clamp technique has recently been questioned by randomized controlled trials comparing the two techniques. Objective: To systematically review the recent literature and perform a quantitative synthesis of dat...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-12-01
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| Series: | European Urology Open Science |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666168323012922 |
| _version_ | 1797391761114398720 |
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| author | Nikita Shrivastava Gopal Sharma Puneet Ahluwalia Gagan Gautam Selcuk Erdem Daniele Amparore Michele Marchioni Nicola Pavan Laura Marandino Eduard Roussel Riccardo Campi Riccardo Bertolo |
| author_facet | Nikita Shrivastava Gopal Sharma Puneet Ahluwalia Gagan Gautam Selcuk Erdem Daniele Amparore Michele Marchioni Nicola Pavan Laura Marandino Eduard Roussel Riccardo Campi Riccardo Bertolo |
| author_sort | Nikita Shrivastava |
| collection | DOAJ |
| description | Context: The superiority of off-clamp robot-assisted partial nephrectomy (RAPN) over the on-clamp technique has recently been questioned by randomized controlled trials comparing the two techniques. Objective: To systematically review the recent literature and perform a quantitative synthesis of data on the comparison of off-clamp versus off-clamp hilar control during RAPN. Evidence acquisition: A systematic search was performed in the PubMed, Embase, Web of Science, and Scopus databases for studies comparing off-clamp versus on-clamp RAPN in terms of perioperative and functional outcomes. The study protocol was registered in the PROSPERO database (CRD42023413160). Only prospective randomized controlled trials and retrospective matched observational studies were included. The primary outcome of the study was the percentage decrease in the estimated glomerular filtration rate (eGFR). Evidence synthesis: A total of 11 studies were included involving a total of 2483 patients (944 patients in the off-clamp and 1539 patients in the on-clamp group). There was no difference between the two groups in the percentage decline in eGFR (mean difference [MD] 0.04%, 95% confidence interval [CI] −3.7% to 3.86%; p = 0.98). There were so significant differences between the groups for length of hospital stay (p = 0.56), complications (p = 0.08), conversion to open or radical surgery (p = 0.18), estimated blood loss (p = 0.06), or need for blood transfusion (p = 0.07). The operative time was shorter in the off-clamp group (MD−21.89 min, 95% CI −42.5 to −1.27; p = 0.04) but after sensitivity analysis the difference was no longer statistically significant (p = 0.15). The positive surgical margin rate was significantly lower in the off-clamp group (odds ratio 0.6, 95% CI 0.39–0.91; p = 0.02). Conclusions: Our review revealed no clinically relevant differences in perioperative and functional outcomes between off-clamp and on-clamp RAPN. Patient summary: In this review, we compared the two methods of controlling the kidney blood vessels during robot-assisted surgery to remove part of the kidney. We noted that there was no difference between the two groups for outcomes such as complications and the decrease in kidney function after surgery. |
| first_indexed | 2024-03-08T23:37:21Z |
| format | Article |
| id | doaj.art-018aa8ab149047c8a04196f1f5b5721b |
| institution | Directory Open Access Journal |
| issn | 2666-1683 |
| language | English |
| last_indexed | 2024-03-08T23:37:21Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | European Urology Open Science |
| spelling | doaj.art-018aa8ab149047c8a04196f1f5b5721b2023-12-14T05:23:47ZengElsevierEuropean Urology Open Science2666-16832023-12-01581018Off-clamp Versus On-clamp Robot-assisted Partial Nephrectomy: A Systematic Review and Quantitative Synthesis by the European Association of Urology Young Academic Urologists Renal Cancer Study GroupNikita Shrivastava0Gopal Sharma1Puneet Ahluwalia2Gagan Gautam3Selcuk Erdem4Daniele Amparore5Michele Marchioni6Nicola Pavan7Laura Marandino8Eduard Roussel9Riccardo Campi10Riccardo Bertolo11Department of Urology, DKS Superspeciality Hospital and Postgraduate Institute, Raipur, IndiaUrologic Oncology and Robotic Surgery, Medanta The Medicity, Gurugram, India; Corresponding authors. Urologic Oncology and Robotic Surgery, Medanta The Medicity, Gurugram, Haryana, India. Tel. +91 98 1830 2207 (G. Sharma). Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy. Tel. +39 392 6725196 (R. Campi).Urologic Oncology and Robotic Surgery, Medanta The Medicity, Gurugram, IndiaUrologic Oncology and Robotic Surgery, Medanta The Medicity, Gurugram, IndiaUrologic Oncology Division, Urology Department, Faculty of Medicine, Istanbul University, Istanbul, TurkeyDivision of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, ItalyLaboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, G. D’Annunzio Chieti-Pescara University, Chieti, Italy; Department of Urology, SS Annunziata Hospital, G. D’Annunzio Chieti-Pescara University, Chieti, ItalyUnit of Urology, Department of Surgical, Oncological and Oral Sciences, P. Giaccone University Hospital, Palermo, ItalyClinical Research Fellow in Renal & Melanoma, Royal Marsden Hospital, London, UKDepartment of Urology, University Hospitals of Leuven, Leuven, BelgiumUnit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Corresponding authors. Urologic Oncology and Robotic Surgery, Medanta The Medicity, Gurugram, Haryana, India. Tel. +91 98 1830 2207 (G. Sharma). Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy. Tel. +39 392 6725196 (R. Campi).Urology Unit, San Carlo di Nancy Hospital, Rome, ItalyContext: The superiority of off-clamp robot-assisted partial nephrectomy (RAPN) over the on-clamp technique has recently been questioned by randomized controlled trials comparing the two techniques. Objective: To systematically review the recent literature and perform a quantitative synthesis of data on the comparison of off-clamp versus off-clamp hilar control during RAPN. Evidence acquisition: A systematic search was performed in the PubMed, Embase, Web of Science, and Scopus databases for studies comparing off-clamp versus on-clamp RAPN in terms of perioperative and functional outcomes. The study protocol was registered in the PROSPERO database (CRD42023413160). Only prospective randomized controlled trials and retrospective matched observational studies were included. The primary outcome of the study was the percentage decrease in the estimated glomerular filtration rate (eGFR). Evidence synthesis: A total of 11 studies were included involving a total of 2483 patients (944 patients in the off-clamp and 1539 patients in the on-clamp group). There was no difference between the two groups in the percentage decline in eGFR (mean difference [MD] 0.04%, 95% confidence interval [CI] −3.7% to 3.86%; p = 0.98). There were so significant differences between the groups for length of hospital stay (p = 0.56), complications (p = 0.08), conversion to open or radical surgery (p = 0.18), estimated blood loss (p = 0.06), or need for blood transfusion (p = 0.07). The operative time was shorter in the off-clamp group (MD−21.89 min, 95% CI −42.5 to −1.27; p = 0.04) but after sensitivity analysis the difference was no longer statistically significant (p = 0.15). The positive surgical margin rate was significantly lower in the off-clamp group (odds ratio 0.6, 95% CI 0.39–0.91; p = 0.02). Conclusions: Our review revealed no clinically relevant differences in perioperative and functional outcomes between off-clamp and on-clamp RAPN. Patient summary: In this review, we compared the two methods of controlling the kidney blood vessels during robot-assisted surgery to remove part of the kidney. We noted that there was no difference between the two groups for outcomes such as complications and the decrease in kidney function after surgery.http://www.sciencedirect.com/science/article/pii/S2666168323012922Off-clampIschemiaPartial nephrectomyKidney cancer |
| spellingShingle | Nikita Shrivastava Gopal Sharma Puneet Ahluwalia Gagan Gautam Selcuk Erdem Daniele Amparore Michele Marchioni Nicola Pavan Laura Marandino Eduard Roussel Riccardo Campi Riccardo Bertolo Off-clamp Versus On-clamp Robot-assisted Partial Nephrectomy: A Systematic Review and Quantitative Synthesis by the European Association of Urology Young Academic Urologists Renal Cancer Study Group European Urology Open Science Off-clamp Ischemia Partial nephrectomy Kidney cancer |
| title | Off-clamp Versus On-clamp Robot-assisted Partial Nephrectomy: A Systematic Review and Quantitative Synthesis by the European Association of Urology Young Academic Urologists Renal Cancer Study Group |
| title_full | Off-clamp Versus On-clamp Robot-assisted Partial Nephrectomy: A Systematic Review and Quantitative Synthesis by the European Association of Urology Young Academic Urologists Renal Cancer Study Group |
| title_fullStr | Off-clamp Versus On-clamp Robot-assisted Partial Nephrectomy: A Systematic Review and Quantitative Synthesis by the European Association of Urology Young Academic Urologists Renal Cancer Study Group |
| title_full_unstemmed | Off-clamp Versus On-clamp Robot-assisted Partial Nephrectomy: A Systematic Review and Quantitative Synthesis by the European Association of Urology Young Academic Urologists Renal Cancer Study Group |
| title_short | Off-clamp Versus On-clamp Robot-assisted Partial Nephrectomy: A Systematic Review and Quantitative Synthesis by the European Association of Urology Young Academic Urologists Renal Cancer Study Group |
| title_sort | off clamp versus on clamp robot assisted partial nephrectomy a systematic review and quantitative synthesis by the european association of urology young academic urologists renal cancer study group |
| topic | Off-clamp Ischemia Partial nephrectomy Kidney cancer |
| url | http://www.sciencedirect.com/science/article/pii/S2666168323012922 |
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