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

Huang, Yin; Cao, Dehong; Chen, Zeyu; Chen, Bo; Li, Jin; Guo, Jing; Dong, Qiang; Wei, Qiang; Liu, Liangren

doi:10.3389/fonc.2021.730662

Cited by 10 publications

(14 citation statements)

References 45 publications

(153 reference statements)

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“…The Newcastle-Ottawa Scale (NOS) and Cochrane Risk of Bias Assessment Tool (CRBAT) were utilized to evaluate the quality of the included studies [18,19]. Studies scoring 7-9 points were considered to be high quality [20]. In addition, the evidence level for every study was also assessed according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence Working Group [21].…”

Section: Quality Assessmentmentioning

confidence: 99%

Balanced crystalloid solutions versus normal saline in intensive care units: a systematic review and meta-analysis

Wang

Huang

et al. 2023

Int Urol Nephrol

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Background Intravenous fluid therapy is important for pediatric and adult patients in intensive care units (ICUs). However, medical professionals continue to struggle to determine the most appropriate fluids to obtain the best possible outcomes for each patient. Objective We conducted a meta-analysis involving cohort studies and randomized controlled trials (RCTs) to compare the influence of balanced crystalloid solutions and normal saline among patients in ICUs. Patients and methods Studies that compared balanced crystalloid solutions and saline in ICU patients from databases including PubMed, Embase, Web of Science, and Cochrane Library were systematically searched up to July 25, 2022. The primary outcomes were mortality and renal-related outcomes, which included major adverse kidney events within 30 days (MAKE30), acute kidney injury (AKI), new receipt of renal replacement therapy (RRT), maximum creatinine increasing, maximum creatinine level, and final creatinine level ≥ 200% of baseline. Service utilization including length of hospital stay, ICU stay, ICU-free days and ventilator-free days were also reported. Results A total of 13 studies (10 RCTs and 3 cohort studies) involving 38,798 patients in ICUs met the selection criteria. Our analysis revealed that each subgroup had no significant difference in mortality outcomes among ICU patients between balanced crystalloid solutions and normal saline. A significant difference was detected between the adult groups (odds ratio [OR], 0.92; 95% confidence interval [CI], [0.86, 1.00]; p = 0.04) indicating that the AKI in the balanced crystalloid solutions group was lower than that in the normal saline group. Other renal-related outcomes, such as MAKE30, RRT, maximum creatinine increasing, maximum creatinine level, and final creatinine level ≥ 200% of baseline showed no significant difference between the two groups. Regarding secondary outcomes, the balanced crystalloid solution group had a longer ICU stay time (WMD, 0.02; 95% CI, [0.01, 0.03]; p = 0.0004 and I2 = 0%; p = 0.96) than the normal saline group among adult patients. Furthermore, children treated with balanced crystalloid solution had a shorter hospital stay time (WMD, − 1.10; 95% CI, [− 2.10, − 0.10]; p = 0.03 and I2 = 17%; p = 0.30) than those treated with saline. Conclusions Compared with saline, balanced crystalloid solutions could not reduce the risk of mortality and renal-related outcomes, including MAKE30, RRT, maximum creatinine increasing, maximum creatinine level, and final creatinine level ≥ 200% of baseline, but the solutions may reduce total AKI incidence among adult patients in ICUs. For service utilization outcomes, balanced crystalloid solutions were associated with a longer length of ICU stay in the adult group and shorter length of hospital stay in the pediatric group.

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Section: Quality Assessmentmentioning

confidence: 99%

Balanced crystalloid solutions versus normal saline in intensive care units: a systematic review and meta-analysis

Wang

Huang

et al. 2023

Int Urol Nephrol

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“…This procedure uses an off‐clamp method to approach the tumor from the hilum, enucleate the tumor, and seal the feeding vessel. Tumor enucleation is reportedly associated with better preservation of renal function than standard partial nephrectomy, 5 although this association is controversial 6 . The off‐clamp approach can make this technique more feasible for surgeons by taking enough time to observe layers and make the surgeons feel less stressed with no need to think about WIT, considering the difficulty and relatively long WIT needed for the hilar RAPN approach 3 .…”

Section: Figurementioning

confidence: 99%

Off‐clamp robot‐assisted partial nephrectomy for renal hilar tumors

Niino,

Goto,

Sazuka

et al. 2023

Int J of Urology

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“…Off-clamp RAPN has been described as an alternative to on-clamp RAPN to avoid the potential negative effects of warm ischaemia on renal function [9]. Systematic reviews and meta-analyses have found mostly similar perioperative outcomes between both approaches [10][11][12], but are limited by the inclusion of non-randomised studies, which contributes to selection bias.…”

Section: Introductionmentioning

confidence: 99%

Off‐clamp vs on‐clamp robot‐assisted partial nephrectomy: a systematic review and meta‐analysis

Fong,

Gan,

Lim

et al. 2023

BJU International

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ObjectiveTo compare intra‐ and postoperative outcomes between off‐clamp and on‐clamp robot‐assisted partial nephrectomy (RAPN), using data from randomised controlled trials (RCTs) or covariate‐matched studies (propensity score‐matched or matched‐pair analysis).MethodsA Preferred Reporting Items for Systematic Reviews and Meta‐Analyses‐compliant literature review was conducted on PubMed, EMBASE, Scopus and CENTRAL for relevant studies comparing off‐clamp to on‐clamp RAPN. Primary outcomes were estimated blood loss, postoperative percentage decrease in estimated glomerular filtration rate (eGFR), and margin positive rate. Secondary outcomes were operative time, postoperative eGFR, length of stay, all postoperative complications, major complications, and need for transfusion. Random‐effects meta‐analyses were performed to generate mean differences (MDs) or odds ratios (ORs).ResultsA total of 10 studies (2307 patients) were shortlisted for analysis. There was no significant difference in estimated operative blood loss between off‐clamp and on‐clamp RAPN (MD 21.9 mL, 95% confidence interval [CI] −0.9 to 44.7 mL; P = 0.06, I2 = 58%). Off‐clamp RAPN yielded a smaller postoperative eGFR deterioration (MD 3.10%, 95% CI 1.05–5.16%; P = 0.008, I2 = 13%) and lower odds of margin positivity (OR 0.62, 95% CI 0.40–0.94; P = 0.03, I2 = 0%). No significant differences were found for all secondary outcomes.ConclusionsOff‐clamp and on‐clamp RAPN are similarly effective approaches for selected renal masses. Within the classic trifecta of PN outcomes, off‐clamp RAPN yields similar rates of perioperative complications and may possibly offer better preservation of renal function and reduced margin‐positive rates.

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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

Cited by 10 publications

References 45 publications

Balanced crystalloid solutions versus normal saline in intensive care units: a systematic review and meta-analysis

Balanced crystalloid solutions versus normal saline in intensive care units: a systematic review and meta-analysis

Off‐clamp robot‐assisted partial nephrectomy for renal hilar tumors

Off‐clamp vs on‐clamp robot‐assisted partial nephrectomy: a systematic review and meta‐analysis

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