On-clamp versus off-clamp partial nephrectomy: Propensity score-matched comparison of long-term functional outcomes.
Adult
Aged
Constriction
Female
Glomerular Filtration Rate
Humans
Kidney Neoplasms
/ mortality
Male
Middle Aged
Multivariate Analysis
Nephrectomy
/ adverse effects
Postoperative Complications
/ epidemiology
Propensity Score
Renal Insufficiency, Chronic
/ physiopathology
Retrospective Studies
Robotic Surgical Procedures
Survival Analysis
Treatment Outcome
Warm Ischemia
functional outcomes
off-clamp
on-clamp
partial nephrectomy
propensity score matching
Journal
International journal of urology : official journal of the Japanese Urological Association
ISSN: 1442-2042
Titre abrégé: Int J Urol
Pays: Australia
ID NLM: 9440237
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
received:
05
03
2019
accepted:
01
07
2019
pubmed:
26
7
2019
medline:
25
9
2020
entrez:
26
7
2019
Statut:
ppublish
Résumé
To compare long-term functional outcomes of off-clamp or on-clamp partial nephrectomy patients of two high-volume centers with cT1-2/N0 M0 renal tumors and baseline estimated glomerular filtration rate >60 mL/min. A 3:1 propensity score-matched analysis was used to select two homogeneous cohorts to compare off-clamp versus on-clamp partial nephrectomy. Joinpoint regression analysis was used to compare the 2-8-year probabilities of estimated glomerular filtration rate modifications in both selected cohorts. The Kaplan-Meier method assessed the risk of developing a stage ≥3b chronic kidney disease during follow up. Multivariable analyses aimed to identify predictors of renal function deterioration. Perioperative complications and oncological outcomes were compared. Overall, 1073 patients were included (588 on-clamp and 485 off-clamp). After applying the propensity score-matched analysis, the two cohorts of 157 on-clamp and 472 off-clamp patients did not differ for all covariates, except for warm ischemia time and last estimated glomerular filtration rate. At joinpoint analysis, the off-clamp group showed higher probabilities of maintaining an unmodified estimated glomerular filtration rate (P = 0.02). The probability of developing a stage ≥3b chronic kidney disease was significantly higher (P < 0.001) in the on-clamp cohort. At multivariable analysis, estimated glomerular filtration rate at discharge and off-clamp approach were independent predictors of improved functional outcomes. Perioperative complications were comparable among the two cohorts (P = 0.67). There were not any statistically significant differences in terms of cancer-specific survival (P = 0.26) and overall survival (P = 0.18). Off-clamp partial nephrectomy seems to offer a higher probability of maintaining 100% estimated glomerular filtration rate after surgery. In our cohort, patients undergoing on-clamp partial nephrectomy presented a 7.3-fold increased risk of developing a severe chronic kidney disease during follow up.
Types de publication
Comparative Study
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
985-991Informations de copyright
© 2019 The Japanese Urological Association.
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