OFF-CLAMP ROBOT ASSISTED PARTIAL NEPHRECTOMY: IS THERE SOMETHING MORE TO ACHIEVE OPTIMAL TRIFECTA OUTCOMES?

Objectives To report trifecta outcomes of our "off-clamp" partial nephrectomy patients operated without main renal artery and/or any selective/superselective clamping. Material and Methods Between April 2008 and March 2020, 52 patients received "off-clamp" robot assisted partial nephrectomy. Postoperative 6th month estimated glomerular filtration rate (eGFR) and eGFR decrease were considered for renal function evaluation. Patients with negative surgical margins, <15% postoperative eGFR decrease and absence of grade ≥ 2 Clavien-Dindo complications were reported to achieve trifecta outcomes. Results Mean age and body mass index of the patients were 57.51 ±12.99 and 27.23 ±4.35 kg/m2, respectively. Mean preoperative Hct, serum creatinine and eGFR were 42.01 ±3.86 %, 0.92 ±0.28 mg/dL and 85.26 ±21.27 mL/min/1.73 m2, respectively. Mean tumor size was 30.32 ±13.64 mm. Mean PADUA and RENAL scores were 7.63 ±1.46 and 6.21 ±1.63, respectively. One patient had focal surgical margin positivity. Mean console time and estimated blood loss was 82.11 ±38.51 minutes and 280.76 ± 278.98 ml., respectively. Complications were observed in 2 (4 %) patients (1 Clavien I, 1 Clavien IIIB). At postoperative 6th month, serum creatinine and eGFR were 0.95 ±0.32 mg/dL and 83.65 ± 22.44 mL/min/1.73 m2, respectively. Eventually 7 patients had ≥ 15% postoperative eGFR decrease, 1 patient had grade ≥ 2 complication and 1 patient had positive surgical margin. Forty-three (83%) patients fulfilled trifecta outcomes. Conclusion Off-clamp partial nephrectomy is important for optimal renal function preservation. Patient selection and additional operative measures along with experience in robotic surgery can contribute achievement of optimal trifecta outcomes.