Your browser doesn't support javascript.
loading
The role of warm ischemia time on functional outcomes after robotic partial nephrectomy: a radionuclide renal scan study from the clock randomized trial.
Antonelli, Alessan Dro; Cindolo, Luca; Sandri, Marco; Veccia, Alessandro; Annino, Filippo; Bertagna, Francesco; Di Maida, Fabrizio; Celia, Antonio; D'Orta, Carlo; De Concilio, Bernardino; Furlan, Maria; Giommoni, Valentina; Ingrosso, Manuela; Mari, Andrea; Nucciotti, Roberto; Olianti, Catia; Porreca, Angelo; Primiceri, Giulia; Schips, Luigi; Sessa, Francesco; Bove, Pierluigi; Simeone, Claudio; Minervini, Andrea.
Afiliación
  • Antonelli AD; Urology Unit, ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy. alessandro.antonelli@univr.it.
  • Cindolo L; Urology Unit, Azienda Ospedaliera Universitaria Integrata Verona, AUOI Verona, University of Verona, 37126, Verona, Italy. alessandro.antonelli@univr.it.
  • Sandri M; Urology Unit, D'Annunzio Hospital, University of Chieti, Chieti, Italy.
  • Veccia A; Big and Open Data Innovation Laboratory (BODaI-Lab), University of Brescia, Brescia, Italy.
  • Annino F; Urology Unit, ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy.
  • Bertagna F; Urology Unit, Azienda Ospedaliera Universitaria Integrata Verona, AUOI Verona, University of Verona, 37126, Verona, Italy.
  • Di Maida F; Urology Unit San Donato Hospital, Arezzo, Italy.
  • Celia A; Nuclear Medicine Unit ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy.
  • D'Orta C; Urology Unit, Careggi Hospital, University of Florence, Florence, Italy.
  • De Concilio B; Urology Unit, San Bassiano Hospital, Bassano Del Grappa, Italy.
  • Furlan M; Urology Unit, D'Annunzio Hospital, University of Chieti, Chieti, Italy.
  • Giommoni V; Urology Unit, San Bassiano Hospital, Bassano Del Grappa, Italy.
  • Ingrosso M; Urology Unit, ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy.
  • Mari A; Urology Unit San Donato Hospital, Arezzo, Italy.
  • Nucciotti R; Urology Unit, D'Annunzio Hospital, University of Chieti, Chieti, Italy.
  • Olianti C; Urology Unit, Careggi Hospital, University of Florence, Florence, Italy.
  • Porreca A; Urology Unit, Misericordia Hospital, Grosseto, Italy.
  • Primiceri G; Nuclear Medicine Unit Careggi Hospital, University of Florence, Florence, Italy.
  • Schips L; Urology Unit, Policlinico of Abano, Abano Terme, Italy.
  • Sessa F; Urology Unit, D'Annunzio Hospital, University of Chieti, Chieti, Italy.
  • Bove P; Urology Unit, D'Annunzio Hospital, University of Chieti, Chieti, Italy.
  • Simeone C; Urology Unit, Careggi Hospital, University of Florence, Florence, Italy.
  • Minervini A; Urology Unit, S. Carlo di Nancy Hospital, Rome, Italy.
World J Urol ; 41(5): 1337-1344, 2023 May.
Article en En | MEDLINE | ID: mdl-37085644
PURPOSE: To evaluate the relationship between warm ischemia time (WIT) duration and renal function after robot-assisted partial nephrectomy (RAPN). METHODS: The CLOCK trial is a phase 3 randomized controlled trial comparing on- vs off-clamp RAPN. All patients underwent pre- and postoperative renal scintigraphy. Six-month absolute variation of eGFR (AV-GFR), rate of relative variation in eGFR over 25% (RV-GFR > 25), absolute variation of split renal function (SRF) at scintigraphy (AV-SRF). The relationships WIT/outcomes were assessed by correlation graphs and then modeled by uni- and multivariable regression. RESULTS: 324 patients were included (206 on-clamp, 118 off-clamp RAPN). Correlation graphs showed a threshold on WIT equal to 10 min. The differences in outcome measures between cases with WIT < vs ≥ 10 min were: AV-GFR - 3.7 vs - 7.5 ml/min (p < 0.001); AV-SRF - 1% vs - 3.6% (p < 0.001); RV-GFR > 25 9.3% vs 17.8% (p = 0.008). Multivariable models found that AV-GFR was related to WIT ≥ 10 min (regression coefficient [RC] - 0.52, p = 0.019), age (RC - 0.35, p = 0.001) and baseline eGFR (RC - 0.30, p < 0.001); RV-GFR > 25 to WIT ≥ 10 min (odds ratio [OR] 1.11, p = 0.007) and acute kidney injury defined as > 50% increase in serum creatinine (OR 19.7, p = 0.009); AV-SRF to WIT ≥ 10 min (RC - 0.30, p = 0.018), baseline SRF (RC - 0.76, p < 0.001) and RENAL score (RC - 0.60. p = 0.028). The main limitation was that the CLOCK trial was designed on a different endpoint and therefore the present analysis could be underpowered. CONCLUSIONS: Up to 10 min WIT had no consequences on functional outcomes. Above the 10-min threshold, a statistically significant, but clinically negligible impact was found.
Asunto(s)
Palabras clave
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Robótica / Procedimientos Quirúrgicos Robotizados / Neoplasias Renales Tipo de estudio: Clinical_trials / Observational_studies / Prognostic_studies Límite: Humans Idioma: En Revista: World J Urol Año: 2023 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Alemania
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Robótica / Procedimientos Quirúrgicos Robotizados / Neoplasias Renales Tipo de estudio: Clinical_trials / Observational_studies / Prognostic_studies Límite: Humans Idioma: En Revista: World J Urol Año: 2023 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Alemania