Evaluation of Perioperative Outcomes and Renal Function after Robotic Assisted Laparoscopic Partial Nephrectomy Off/On Clamp: Comparison of cT1a versus cT1b Renal Masses
Introduction: Partial nephrectomy (PN) is the standard of care for cT1a (4-7 cm (cT1b), and these patients were subdivided C) 15 patients Off Clamp (no ischemia) RALPN vs. D) 20 patients OnClamp (ischemia) RALPN. Patients demographic, perioperative outcomes and renal function are evaluated at 6 months. Results: In all, 35 patients underwent RALPN no conversion to open. The patient’s demographics and perioperative factors characteristics were similar among these 2 groups. Transfusion were more common in cT1b (13.3%) this difference was significant. The EBL was larger in the off-clamp RALPN cohort (350–415 vs. 55–75 mL). The percentage change in eGFR after 6 months in the cT1b on-Clamp RALPN was significantly (-9.5%) as compared to cT1a (-3.4%). This can be related to ischemia injury or renal parenchymal loss. Conclusion: RALPN can be performed off-clamp in selected patients with cT1b (4-7 cm) renal tumors without compromising operative duration, length of stay, rates of positive margins, and postoperative complications. Careful, discussion with patients and anesthesia team about the increases of EBL and possible transfusion is recommended and decreases of the renal function by 9-10% at 6 months. Further studies with longer follow-up are needed to elucidate the impact of ischemia on long-term renal function and correlate it with tumor volume and renal parenchymal loss.
Hugo H Davila, Raul E Storey, Renzo G Di Natale and Noor Merchant