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Antonelli AD, Cindolo L, Sandri M, Veccia A, Annino F, Bertagna F, Di Maida F, Celia A, D'Orta C, De Concilio B, Furlan M, Giommoni V, Ingrosso M, Mari A, Nucciotti R, Olianti C, Porreca A, Primiceri G, Schips L, Sessa F, Bove P, Simeone C, Minervini A. The role of warm ischemia time on functional outcomes after robotic partial nephrectomy: a radionuclide renal scan study from the clock randomized trial. World J Urol 2023; 41:1337-1344. [PMID: 37085644 DOI: 10.1007/s00345-023-04366-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/06/2023] [Indexed: 04/23/2023] Open
Abstract
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.
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Affiliation(s)
- Alessan Dro Antonelli
- Urology Unit, ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy.
- Urology Unit, Azienda Ospedaliera Universitaria Integrata Verona, AUOI Verona, University of Verona, 37126, Verona, Italy.
| | - Luca Cindolo
- Urology Unit, D'Annunzio Hospital, University of Chieti, Chieti, Italy
| | - Marco Sandri
- Big and Open Data Innovation Laboratory (BODaI-Lab), University of Brescia, Brescia, Italy
| | - Alessandro Veccia
- Urology Unit, ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy
- Urology Unit, Azienda Ospedaliera Universitaria Integrata Verona, AUOI Verona, University of Verona, 37126, Verona, Italy
| | | | - Francesco Bertagna
- Nuclear Medicine Unit ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Fabrizio Di Maida
- Urology Unit, Careggi Hospital, University of Florence, Florence, Italy
| | - Antonio Celia
- Urology Unit, San Bassiano Hospital, Bassano Del Grappa, Italy
| | - Carlo D'Orta
- Urology Unit, D'Annunzio Hospital, University of Chieti, Chieti, Italy
| | | | - Maria Furlan
- Urology Unit, ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | | | - Manuela Ingrosso
- Urology Unit, D'Annunzio Hospital, University of Chieti, Chieti, Italy
| | - Andrea Mari
- Urology Unit, Careggi Hospital, University of Florence, Florence, Italy
| | | | - Catia Olianti
- Nuclear Medicine Unit Careggi Hospital, University of Florence, Florence, Italy
| | | | - Giulia Primiceri
- Urology Unit, D'Annunzio Hospital, University of Chieti, Chieti, Italy
| | - Luigi Schips
- Urology Unit, D'Annunzio Hospital, University of Chieti, Chieti, Italy
| | - Francesco Sessa
- Urology Unit, Careggi Hospital, University of Florence, Florence, Italy
| | | | - Claudio Simeone
- Urology Unit, ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Andrea Minervini
- Urology Unit, Careggi Hospital, University of Florence, Florence, Italy
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