title: Margin and complication rates in clampless partial nephrectomy: a comparison of open, laparoscopic and robotic surgeries.
abstract: In performing partial nephrectomy (PN), surgeons focus on complete removal of tumor, preservation of renal function, the absence of major perioperative complications, expressed by the formula margin, ischemia and complication (MIC). The aim of current study was to perform a single-institution comparison of clampless open (OPN), laparoscopic (LPN) or robot-assisted (RAPN) PN as well as to evaluate pre-, intra- and postoperative factors that may influence achievement of ideal MIC. All consecutive clampless OPN, LPN or RAPN performed by experienced surgeons between 2006 and 2015 were included in the analysis. MIC was defined as negative surgical margin plus zero-ischemia plus absence of any grade ≥3 complications according to Clavien-Dindo classification. Bivariate and multivariate logistic regression models were fitted to predict the MIC. Odds ratios with 95 % confidence intervals were calculated. 80 patients underwent OPN, 66 LPN and 31 RAPN, and both groups had similar characteristics. The MIC rate was 67.5, 86.3 and 83.3 % in the OPN, LPN and RAPN groups, respectively (p = 0.016). At logistic regression analysis, surgical approach (p = 0.03) and operative time (p = 0.008) were independent predictors of the MIC rate. When stratified according to the surgical approach, preoperative aspects and dimensions used for an anatomical classification (PADUA) score, LPN, RAPN and operative time were independent predictors of MIC rate (p = 0.0488, p = 0.0494, p = 0.0479 and p = 0.0108, respectively). Clampless LPN and RAPN have an efficacy and safety profile that is on par with OPN, offering the additional benefits of a reduced operative time, blood loss, on demand ischemia and rate of high-grade complications.
authors.affiliation: Urology Department, Perugia Hospital, Sant'Andrea delle Fratte, University of Perugia, 06100, Perugia, Italy. luigi.mearini@tin.it.
authors.forename: Luigi
authors.initials: L
authors.lastname: Mearini
authors.affiliation: Urology Department, Perugia Hospital, Sant'Andrea delle Fratte, University of Perugia, 06100, Perugia, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Nunzi
authors.affiliation: Urology Department, Perugia Hospital, Sant'Andrea delle Fratte, University of Perugia, 06100, Perugia, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Vianello
authors.affiliation: Urology Department, Perugia Hospital, Sant'Andrea delle Fratte, University of Perugia, 06100, Perugia, Italy.
authors.forename: Manuel
authors.initials: M
authors.lastname: Di Biase
authors.affiliation: Urology Department, Perugia Hospital, Sant'Andrea delle Fratte, University of Perugia, 06100, Perugia, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Porena
mesh_terms: D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D007902:Length of Stay; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D009392:Nephrectomy / Q000295:instrumentation / Q000379:methods*; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D065287:Robotic Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D013525:Surgical Instruments; D016896:Treatment Outcome; D052096:Warm Ischemia
keywords: Clampless technique; Laparoscopy; Open surgery; Partial nephrectomy; Robot-assisted