Objective: To evaluate the perioperative outcomes, functional impact, and oncologic efficacy of off-clamp robotic-assisted partial nephrectomy (RAPN) in patients with renal masses across multiple high-volume centers. Materials and Methods: We conducted a retrospective multicenter study including 563 patients (group 1) who underwent clampless RAPN between January 2018 and December 2024. Patients with solitary kidneys, tumors >7 cm, or prior renal surgery were excluded. The standardized surgical technique involved tumor resection without clamping of the renal artery, followed by the use of hemostatic agents and standard/selective suturing of the resection bed on demand. Patients in group 1 were compared to 244 consecutive patients treated in the same centres and treated with RAPN with an on-clamp procedure (group 2). Primary outcomes included operative time, blood loss, and complications, while secondary outcomes assessed renal function preservation and oncologic control at an at least 12-month follow-up. Results: The median operative time was 118 min (IQR: 100–140 min), and median estimated blood loss was 150 mL (range: 50–400 mL). The overall complication rate was 9.2%, with most classified as Clavien–Dindo Grade I–II. No intraoperative conversions to open surgery were recorded. Renal function was well preserved, with a median estimated glomerular filtration rate (eGFR) decline of 4.1% at three months (p> 0.05), and no cases of acute kidney injury. Oncologic outcomes were favorable, with a positive surgical margin rate (PSM) of 2.4% and two cases of tumor recurrences (0.36%) documented at a 12-month follow-up. Conclusions: The off-clamp RAPN is a safe and effective nephron-sparing approach, offering significant renal function preservation while maintaining oncologic efficacy. This technique minimizes ischemia–reperfusion injury and post-surgical fibrosis, providing a viable alternative to on-clamp RAPN. Further prospective trials are warranted to confirm long-term benefits and refine patient selection criteria.
目的：评估多中心高手术量背景下，无阻断机器人辅助肾部分切除术（RAPN）治疗肾肿瘤患者的围手术期结局、功能影响及肿瘤学疗效。材料与方法：本研究为一项回顾性多中心研究，纳入2018年1月至2024年12月期间接受无阻断RAPN的563例患者（第1组）。排除孤立肾、肿瘤直径＞7 cm或既往有肾脏手术史的患者。标准化手术技术包括在不阻断肾动脉的情况下切除肿瘤，随后使用止血剂并根据需要行标准/选择性切除床缝合。将第1组患者与同一中心连续收治的244例接受传统肾动脉阻断下RAPN的患者（第2组）进行比较。主要结局指标包括手术时间、出血量和并发症发生率，次要结局指标评估至少12个月随访期的肾功能保留情况及肿瘤控制效果。结果：中位手术时间为118分钟（四分位距：100–140分钟），中位估计失血量为150 mL（范围：50–400 mL）。总体并发症发生率为9.2%，其中大部分为Clavien–Dindo I–II级。无术中中转开放手术病例。肾功能保留良好，术后三个月估算肾小球滤过率（eGFR）中位下降幅度为4.1%（p＞0.05），且未发生急性肾损伤病例。肿瘤学结局良好，手术切缘阳性率为2.4%，12个月随访期间记录到2例肿瘤复发（0.36%）。结论：无阻断RAPN是一种安全有效的保留肾单位术式，在维持肿瘤学疗效的同时显著保护肾功能。该技术可最大程度减少缺血再灌注损伤及术后纤维化，为传统阻断式RAPN提供了可行的替代方案。未来需开展前瞻性试验以确认其长期获益并完善患者选择标准。
肿瘤(癌症)患者之家