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Meta-Analysis
. 2024 Apr;133(4):375-386.
doi: 10.1111/bju.16250. Epub 2023 Dec 30.

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

Khi Yung Fong  1 , Valerie Huei Li Gan  2   3 , Benjamin Jia Han Lim  2 , Yiong Huak Chan  4 , Daniele Castellani  5 , Kenneth Chen  2 , Kae Jack Tay  2 , Henry Sun Sien Ho  2 , John Shyi Peng Yuen  2 , Edwin Aslim  2 , Jeremy Teoh  6 , Ee Jean Lim  2
Affiliations
Meta-Analysis

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

Khi Yung Fong et al. BJU Int. 2024 Apr.

Abstract

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, 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.

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.

Keywords: meta-analysis; partial nephrectomy; renal tumour; robotic surgery; systematic review.

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