Evaluation of oncological outcomes of robotic partial nephrectomy according to the type of hilar control approach (On-clamp vs Off-clamp), a multicentric study of the French network of research on kidney cancer—UROCCR 58-NCT03293563

Mellouki, A.; Bentellis, I.; Morrone, A.; Doumerc, N.; Beauval, Jean-Baptiste; Rouprêt, M.; Nouhaud, François-Xavier; Lebâcle, C.; Long, Jean-Alexandre; Chevallier, D.; Tibi, B.; Shaikh, A.; Phalecque, Laetitia Imbert de la; Pillot, P.; Tillou, X.; Bernhard, Jean‐Christophe; Durand, Matthieu; Ahallal, Y.

doi:10.1007/s00345-020-03558-5

Cited by 8 publications

(20 citation statements)

References 31 publications

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“…Finally, 21 full-text articles involving 4,493 patients (1,274 off-clamp versus 3,219 on-clamp) were included for the pooled analysis ( 9 – 29 ). Of these articles, 7 were prospective cohort studies ( 9 , 10 , 12 , 13 , 16 , 18 , 25 , 27 ), 10 were retrospective cohort studies ( 11 , 14 , 15 , 17 , 19 – 21 , 23 , 24 , 29 ), and 3 were prospective randomized studies ( 22 , 26 , 28 ). Table 1 shows the characteristics, level of evidence, and quality score of each included study.…”

Section: Resultsmentioning

confidence: 99%

“…Table 1 shows the characteristics, level of evidence, and quality score of each included study. The median (range) quality score was 7 ( 5 – 8 ), and 15 studies were identified as high quality ( 9 , 11 , 12 , 14 , 16 – 24 , 28 , 29 ). The details of quality assessment of all eligible studies are presented in Supplementary Table S3 .…”

Section: Resultsmentioning

confidence: 99%

“…Analysis of EBL was conducted in 16 studies with 3,338 patients (835 off-clamp versus 2503 on-clamp) ( 9 , 11 – 16 , 18 – 22 , 24 , 26 , 27 , 29 ). Pooled analysis detected a significantly higher EBL in the off-clamp group (WMD: 20.27; 95% CI: 6.11, 34.44; p = 0.005) with a statistically significant heterogeneity ( I 2 = 79%, p < 0.00001) ( Figure 2B ).…”

Section: Resultsmentioning

confidence: 99%

“…Data of the complication rate (including intraoperative and/or postoperative complications) were available in 19 studies with a total of 3,847 patients (1,061 off-clamp versus 2,786 on-clamp) ( 9 – 11 , 13 – 27 , 29 ). Pooled analysis revealed a significantly lower rate of complication in the off-clamp group compared with the on-clamp group (OR: 0.72; 95% CI: 0.57, 0.92; p = 0.009) ( Figure 2E ).…”

Section: Resultsmentioning

confidence: 99%

“…In recent years, under the condition of more and more surgeons performing the RAPN with zero ischemia technique, namely, the off-clamp approach to minimize the WIT ( 8 ), plenty of studies have been conducted to identify whether the off-clamp RAPN is superior to the on-clamp in efficacy and safety, especially in postoperative renal function preservation ( 9 – 29 ). However, consensus of which clamping technique in RAPN is optimal with respect of perioperative, renal functional, and oncological outcomes remains controversial.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Perioperative, Renal Functional, and Oncological Outcomes Between Off-Clamp and On-Clamp Robot-Assisted Partial Nephrectomy for Renal Tumors: An Updated Evidence-Based Analysis

et al. 2021

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ObjectivesWe aimed to report the latest and largest pooled analysis and evidence update to compare the perioperative, renal functional, and oncological outcomes between off-clamp and on-clamp robot-assisted partial nephrectomy (RAPN) for renal tumors.Patients and methodsWe performed a systematic literature search using PubMed, Embase, and Web of Science up to August 2021 for studies that compared the efficacy and/or safety between off-clamp and on-clamp RAPN for renal tumors. Outcomes measured were operating time, estimated blood loss (EBL), conversion rate, length of stay (LOS), complication rate, transfusion rate, long-term % decrease in estimated glomerular filtration rate (eGFR), positive surgical margin rate, and recurrence rate.ResultsA total of 21 eligible articles involving 4,493 patients (1,274 off-clamp versus 3,219 on-clamp) were included for the evidence synthesis. Baseline characteristics of the two groups were similar in all outcomes except that lower R.E.N.A.L. score and smaller tumor size were observed in the off-clamp group. Pooled analysis showed shorter operative time, higher EBL, and lower complication rate in the off-clamp group. No significant difference was observed in the conversion rate, LOS, and transfusion rate. The recurrence rates were similar in the two groups, while a lower positive surgical margin rate was observed in the off-clamp group. Finally, the off-clamp group had a superior postoperative renal functional outcome.ConclusionsGiven the presence of heterogeneity and potential bias, urologists should select the clamp strategy based on their experience and patient-specific factors.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Comparison of Perioperative, Renal Functional, and Oncological Outcomes Between Off-Clamp and On-Clamp Robot-Assisted Partial Nephrectomy for Renal Tumors: An Updated Evidence-Based Analysis

et al. 2021

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Volume-outcome relationship in intra-abdominal robotic-assisted surgery: a systematic review

et al. 2022

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As robotic assisted surgery (RAS) expands to smaller centres, platforms are shared between specialities.Healthcare providers must consider case volume and mix required to maintain quality and cost-effectiveness. This can be informed, in-part, by the volume-outcome relationship. We perform a systematic review to describe the volume-outcome relationship in intra-abdominal robotic assisted surgery to report on suggested minimum volumes standards. A literature search of Medline, NICE Evidence Search, Health Technology Assessment Database and Cochrane Library using the terms: "robot*", "surgery", "volume" and "outcome" was performed. The included procedures were gynaecological: hysterectomy, urological: partial and radical nephrectomy, cystectomy, prostatectomy, and general surgical: colectomy, oesophagectomy. Hospital and surgeon volume measures and all reported outcomes were analysed. 41 studies, including 983149 procedures, met the inclusion criteria. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale and the retrieved data was synthesised in a narrative review. Signi cant volume-outcome relationships were described in relation to key outcome measures, including operative time, complications, positive margins, lymph node yield and cost. Annual surgeon and hospital volume thresholds were described. We concluded that in centres with an annual volume of fewer than 10 cases of a given procedure, having multiple surgeons performing these procedures led to worse outcomes and, therefore, opportunities should be sought to perform other complimentary robotic procedures or undertake joint cases.

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A systematic review of robot-assisted partial nephrectomy outcomes for advanced indications: Large tumors (cT2-T3), solitary kidney, completely endophytic, hilar, recurrent, and multiple renal tumors

Pandolfo,

Cerrato,

et al. 2023

Asian Journal of Urology

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Evaluation of oncological outcomes of robotic partial nephrectomy according to the type of hilar control approach (On-clamp vs Off-clamp), a multicentric study of the French network of research on kidney cancer—UROCCR 58-NCT03293563

Cited by 8 publications

References 31 publications

Comparison of Perioperative, Renal Functional, and Oncological Outcomes Between Off-Clamp and On-Clamp Robot-Assisted Partial Nephrectomy for Renal Tumors: An Updated Evidence-Based Analysis

Comparison of Perioperative, Renal Functional, and Oncological Outcomes Between Off-Clamp and On-Clamp Robot-Assisted Partial Nephrectomy for Renal Tumors: An Updated Evidence-Based Analysis

Volume-outcome relationship in intra-abdominal robotic-assisted surgery: a systematic review

A systematic review of robot-assisted partial nephrectomy outcomes for advanced indications: Large tumors (cT2-T3), solitary kidney, completely endophytic, hilar, recurrent, and multiple renal tumors

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