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

Autor: Fong KY; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore., Gan VHL; Department of Urology, Singapore General Hospital, Singapore, Singapore.; SingHealth Duke-NUS Transplant Centre, Singapore, Singapore., Lim BJH; Department of Urology, Singapore General Hospital, Singapore, Singapore., Chan YH; Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore., Castellani D; Urology Unit, Azienda Ospedaliero-Universitaria Delle Marche, Università Politecnica delle Marche, Ancona, Italy., Chen K; Department of Urology, Singapore General Hospital, Singapore, Singapore., Tay KJ; Department of Urology, Singapore General Hospital, Singapore, Singapore., Ho HSS; Department of Urology, Singapore General Hospital, Singapore, Singapore., Yuen JSP; Department of Urology, Singapore General Hospital, Singapore, Singapore., Aslim E; Department of Urology, Singapore General Hospital, Singapore, Singapore., Teoh J; S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China., Lim EJ; Department of Urology, Singapore General Hospital, Singapore, Singapore.
Jazyk: angličtina
Zdroj: BJU international [BJU Int] 2024 Apr; Vol. 133 (4), pp. 375-386. Date of Electronic Publication: 2023 Dec 30.
DOI: 10.1111/bju.16250
Abstrakt: Objective: To 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).
Methods: A 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).
Results: A 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, I 2  = 58%). Off-clamp RAPN yielded a smaller postoperative eGFR deterioration (MD 3.10%, 95% CI 1.05-5.16%; P = 0.008, I 2  = 13%) and lower odds of margin positivity (OR 0.62, 95% CI 0.40-0.94; P = 0.03, I 2  = 0%). No significant differences were found for all secondary outcomes.
Conclusions: Off-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.
(© 2023 BJU International.)
Databáze: MEDLINE
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