WCE 2017: Prostate Cancer Screening: How to use PSA in 2017

Vancouver, Canada (UroToday.com) Dr. Kyle Blum, urology research fellow from the Icahn School of Medicine at Mount Sinai, presented data that tests whether or not the Off-Clamp (OC) technique in robotic partial nephrectomy is beneficial for patients without chronic kidney disease and with low complexity, T1a renal masses. Dr. Blum argued that some groups have advocated the OC technique to eliminate warm ischemia whenever possible. No studies have yet examined whether or not this is functionally advantageous in these patients as compared to main arterial clamping (MAC).

Out of 351 patients retrospectively identified between 2008 and 2016 with baseline eGFR ≥ 60, both kidneys, a T1a tumor, and a R.E.N.A.L. score < 10, 82 patients who underwent MAC and 41 patients who underwent OC were screened and analyzed. Perioperative factors including margins, complications, blood loss, and operative time were compared between these two cohorts of patients. There were no statistically significant differences in baseline demographic or tumor-specific characteristics such as tumor size or R.E.N.A.L. scores when patients were matched.

It was determined that there was a greater estimated blood loss (EBL) for OC patients than MAC patients. Besides this singular factor, there was no significant difference in any of the following categories: complications, excisional volume loss, acute kidney injury, percent change in eGFR at discharge, progression to chronic kidney disease, and percent change in eGFR at last follow-up.

Dr. Blum concluded his presentation by reaffirming that OC treatment is safe. However, he did want to educate the audience in his conclusion that there is an increased risk of a greater perioperative EBL and there is no functional outcome benefit in patients with a T1a renal tumor without compromised renal function.

Authors: Daniel C. Rosen, Kyle A. Blum, David J. Paulucci, Ronney Abaza, Daniel D. Eun, Akshay Bhandari, Ashok K. Hemal, Ketan K. Badani
Affiliation: Icahn School of Medicine – Mount Sinai

Speaker: Kyle Blum, MD

Written By: Zachary Valley, Department of Urology, University of California-Irvine at the 35th World Congress of Endourology – September 12-16, 2017, Vancouver, Canada