Comparison of safety and clinical outcomes between Off-clamp and On-clamp robot-assisted partial nephrectomy for cT1 renal cell carcinoma

doi:10.3877/cma.j.issn.1674-3253.2026.05.006

Abstract

Abstract:

Objective

To compare the safety and clinical outcomes of off-clamp robot-assisted partial nephrectomy (Off-clamp RAPN) versus on-clamp robot-assisted partial nephrectomy (On-clamp RAPN) in the treatment of cT₁ renal cell carcinoma (RCC).

Methods

The clinical data of 122 patients with cT₁ RCC who underwent RAPN at the First Affiliated Hospital of Harbin Medical University from April 2021 to September 2024 were retrospectively analyzed. Among these, 66 patients underwent Off-clamp RAPN and 56 underwent On-clamp RAPN. There were no statistically significant differences between the two groups in terms of age, gender, body mass index (BMI), maximum tumor diameter, R.E.N.A.L. score, preoperative serum creatinine (Scr), preoperative estimated glomerular filtration rate (eGFR), and other baseline characteristics (P>0.05). The clinical outcomes compared between the two groups included operation time, postoperative renal function indicators, intraoperative blood loss, postoperative recovery, and complications.

Results

All 122 surgeries were successfully completed, with no conversions to open surgery, radical nephrectomy, renal artery clamping, or positive surgical margin. The operation time for the Off-clamp group was [122.50 (100.75, 150.00) min], compared to [140.00 (115.00, 162.75) min] for the On-clamp group, which was statistically significant (P=0.034). There were no significant differences in intraoperative blood loss, postoperative hospital stay, and postoperative hemoglobin drop between the two groups (P>0.05). The Off-clamp group demonstrated a lower incidence of postoperative acute kidney injury (7.58% vs 25.00%), a lower three-day Scr rise rate [8.38% (3.10%, 17.54%) vs 21.42% (12.80%, 34.67%)], a lower three-day eGFR decline rate [2.76% (1.04%, 5.75%) vs 6.88% (4.11%, 11.40%)], a lower three-month Scr rise rate [6.72% (5.62%, 8.22%) vs 8.79% (6.69%, 12.82%)], and a lower three-month eGFR decline rate [2.23% (1.83%, 3.15%) vs 2.92% (2.26%, 4.65%)] compared to the On-clamp group, all of which were statistically significant (P<0.05). The "trifecta" achievement rates were 80.30% and 60.71% for the Off-clamp and On-clamp groups, respectively (P=0.029).

Conclusion

Off-clamp RAPN is a safe, feasible, and effective alternative to On-clamp RAPN for the treatment of cT₁ RCC when applied to appropriately selected patients. It offers superior renal function preservation, shorter operative time, and higher trifecta achievement rates, while maintaining comparable oncological outcomes and complication rates. However, long-term efficacy and renal functional changes require further investigation.

Key words: Off-clamp, Renal function preservation, Renal cell carcinoma, Partial nephrectomy, Robot-assisted laparoscopy

Guoling Zhang, Yue Xue, Haoxun Zhang, Jiuliang Wang, Zhixing Jiao, Guang Jia, Ao Qi, Yipeng Yu, Bowen Wang, Feng Xiong, Chunyang Wang. Comparison of safety and clinical outcomes between Off-clamp and On-clamp robot-assisted partial nephrectomy for cT₁ renal cell carcinoma[J]. Chinese Journal of Endourology(Electronic Edition), 2026, 20(05): 527-533.

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References 24

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组别	例数	性别[例（%）]		年龄[岁，M(Q)]	ASA分级[例（%）]			BMI[kg/m²，M(Q)]	手术入路[例（%）]
组别	例数	女	男	年龄[岁，M(Q)]	1	2	3	BMI[kg/m²，M(Q)]	经腹膜后	经腹腔
Off-clamp RAPN组	66	29 (43.94)	37 (56.06)	60.00 (51.25，65.00)	5 (7.58)	25 (37.88)	36 (54.55)	26.08 (24.05，28.06)	58 (87.88)	8 (12.12)
On-clamp RAPN组	56	27 (48.21)	29 (51.79)	56.00 (48.75，63.00)	3 (5.36)	26 (46.43)	27 (48.21)	25.74 (23.14，27.82)	47 (83.93)	9 (16.07)
统计值		χ²=0.080		Z=1.633	χ²=1.145			Z=0.345	χ²=0.130
P值		0.772		0.104	0.650			0.733	0.715
组别	肿瘤侧别[例（%）]		肿瘤最大径[cm，M(Q)]	R.E.N.A.L.评分[M(Q)]	术前Scr[μmol/L，(±s)]	术前eGFR[mL/(min·1.73m²)，M(Q)]	术前血红蛋白[g/L，M(Q)]
组别	左	右	肿瘤最大径[cm，M(Q)]	R.E.N.A.L.评分[M(Q)]	术前Scr[μmol/L，(±s)]	术前eGFR[mL/(min·1.73m²)，M(Q)]	术前血红蛋白[g/L，M(Q)]
Off-clamp RAPN组	33 (50.00)	33 (50.00)	2.92 (2.33，3.51)	6.00 (5.00，7.00)	72.50±15.56	90.08 (85.74，99.84)	146.00 (131.25，155.00)
On-clamp RAPN组	24 (42.86)	32 (57.14)	3.30 (2.55，4.06)	6.00 (5.00，7.00)	67.84±17.95	94.03 (87.35，104.25)	144.00 (134.00，154.00)
统计值	χ²=0.370		Z=-1.870	Z=0.298	t=1.540	Z=-1.653	Z=-0.001
P值	0.545		0.061	0.762	0.132	0.099	0.999

组别	例数	性别[例（%）]		年龄[岁，M(Q)]	ASA分级[例（%）]			BMI[kg/m²，M(Q)]	手术入路[例（%）]
组别	例数	女	男	年龄[岁，M(Q)]	1	2	3	BMI[kg/m²，M(Q)]	经腹膜后	经腹腔
Off-clamp RAPN组	66	29 (43.94)	37 (56.06)	60.00 (51.25，65.00)	5 (7.58)	25 (37.88)	36 (54.55)	26.08 (24.05，28.06)	58 (87.88)	8 (12.12)
On-clamp RAPN组	56	27 (48.21)	29 (51.79)	56.00 (48.75，63.00)	3 (5.36)	26 (46.43)	27 (48.21)	25.74 (23.14，27.82)	47 (83.93)	9 (16.07)
统计值		χ²=0.080		Z=1.633	χ²=1.145			Z=0.345	χ²=0.130
P值		0.772		0.104	0.650			0.733	0.715
组别	肿瘤侧别[例（%）]		肿瘤最大径[cm，M(Q)]	R.E.N.A.L.评分[M(Q)]	术前Scr[μmol/L，(±s)]	术前eGFR[mL/(min·1.73m²)，M(Q)]	术前血红蛋白[g/L，M(Q)]
组别	左	右	肿瘤最大径[cm，M(Q)]	R.E.N.A.L.评分[M(Q)]	术前Scr[μmol/L，(±s)]	术前eGFR[mL/(min·1.73m²)，M(Q)]	术前血红蛋白[g/L，M(Q)]
Off-clamp RAPN组	33 (50.00)	33 (50.00)	2.92 (2.33，3.51)	6.00 (5.00，7.00)	72.50±15.56	90.08 (85.74，99.84)	146.00 (131.25，155.00)
On-clamp RAPN组	24 (42.86)	32 (57.14)	3.30 (2.55，4.06)	6.00 (5.00，7.00)	67.84±17.95	94.03 (87.35，104.25)	144.00 (134.00，154.00)
统计值	χ²=0.370		Z=-1.870	Z=0.298	t=1.540	Z=-1.653	Z=-0.001
P值	0.545		0.061	0.762	0.132	0.099	0.999

组别	例数	手术时间[min，M（Q）]	热缺血时间[min，M（Q）]	术后血红蛋白[g/dL，(±s)]	术后血红蛋白下降量[g/dL，(±s)]
Off-clamp RAPN组	66	122.50 (100.75，150.00)	0	128.53±19.65	14.09±10.07
On-clamp RAPN组	56	140.00 (115.00，162.75)	27.00 (23.00，30.00)	129.59±18.11	13.34±9.76
统计值		Z=-2.117	Z=-10.478	t=-0.310	t=-0.420
P值		0.034	<0.001	0.758	0.677
组别	术中估计失血量[mL，M（Q）]	术后住院时间[d，M（Q）]	输血[例（%）]	切缘阳性[例（%）]	三连胜[例（%）]
Off-clamp RAPN组	75.00 (50.00，100.00)	5.00 (4.00，6.00)	8 (12.12)	0	53 (80.30)
On-clamp RAPN组	50.00 (50.00，100.00)	6.00 (5.00，6.00)	6 (10.71)	0	34 (60.71)
统计值	Z=-1.701	Z=-1.792	χ²=0	-	χ²=4.770
P值	0.089	0.073	>0.999	-	0.029

组别	例数	手术时间[min，M（Q）]	热缺血时间[min，M（Q）]	术后血红蛋白[g/dL，(±s)]	术后血红蛋白下降量[g/dL，(±s)]
Off-clamp RAPN组	66	122.50 (100.75，150.00)	0	128.53±19.65	14.09±10.07
On-clamp RAPN组	56	140.00 (115.00，162.75)	27.00 (23.00，30.00)	129.59±18.11	13.34±9.76
统计值		Z=-2.117	Z=-10.478	t=-0.310	t=-0.420
P值		0.034	<0.001	0.758	0.677
组别	术中估计失血量[mL，M（Q）]	术后住院时间[d，M（Q）]	输血[例（%）]	切缘阳性[例（%）]	三连胜[例（%）]
Off-clamp RAPN组	75.00 (50.00，100.00)	5.00 (4.00，6.00)	8 (12.12)	0	53 (80.30)
On-clamp RAPN组	50.00 (50.00，100.00)	6.00 (5.00，6.00)	6 (10.71)	0	34 (60.71)
统计值	Z=-1.701	Z=-1.792	χ²=0	-	χ²=4.770
P值	0.089	0.073	>0.999	-	0.029

组别	例数	术后AKI[例（%）]	术后3天Scr[μmol/L，M（Q）]	术后3天Scr上升率[%，M（Q）]	术后3天eGFR[ml/（min·1.73m²），M（Q）]	术后3天eGFR下降率[%，M（Q）]
Off-clamp RAPN组	66	5 (7.58)	77.20 (65.65，91.30)	8.38 (3.10，17.54)	87.05 (83.50，94.98)	2.76 (1.04，5.75)
On-clamp RAPN组	56	14 (25.00)	81.45 (65.78，106.50)	21.42 (12.80，34.67)	86.93 (78.02，98.24)	6.88 (4.11, 11.40)
统计值		χ²=5.730	Z=-0.764	Z=-4.499	Z=-0.141	Z=-5.425
P值		0.017	0.445	<0.001	0.888	<0.001
组别	术后3个月Scr[μmol/L，M（Q）]	术后3个月Scr上升率[%，M（Q）]	术后3个月eGFR[mL/（min·1.73m²），M（Q）]	术后3个月eGFR下降率[%，M（Q）]
Off-clamp RAPN组	77.85 (65.93，88.45)	6.72 (5.62，8.22)	88.70 (83.98，97.75)	2.23 (1.83，3.15)
On-clamp RAPN组	73.13 (61.88，83.03)	8.79 (6.69，12.82)	90.46 (83.28，102.98)	2.92 (2.26，4.65)
统计值	Z=-0.796	Z=-4.855	Z=-0.901	Z=-5.019
P值	0.426	<0.001	0.367	<0.001

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