Evaluation of oncological outcomes of robotic partial nephrectomy according to the type of hilar control approach (On-clamp vs Off-clamp), a multicentric study of the French network of research on kidney cancer—UROCCR 58-NCT03293563



To compare off-clamp vs on-clamp robotic partial nephrectomy (RPN) for renal cell carcinoma (RCC) in terms of oncological outcomes, and to assess the impact of surgical experience (SE).


We extracted data of a contemporary cohort of 1359 patients from the prospectively maintained database of the French national network of research on kidney cancer (UROCCR). The primary objective was to assess the positive surgical margin (PSM) rate. We also evaluated the oncological outcomes regardless of the surgical experience (SE) by dividing patients into three groups of SE as a secondary endpoints. SE was defined by the caseload of RPN per surgeon per year. For the continuous variables, we used Mann–Whitney and Student tests. We assessed survival analysis according to hilar control approach by Kaplan–Meier curves with log rank tests. A logistic regression multivariate analysis was used to evaluate the independent factors of PSM.


Outcomes of 224 off-clamp RPN for RCC were compared to 1135 on-clamp RPN. PSM rate was not statistically different, with 5.6% in the off-clamp group, and 11% in the on-clamp group (p = 0.1). When assessing survival analysis for overall survival (OS), local recurrence-free survival (LR), and metastasis-free survival (MFS) according to hilar clamping approach, there were no statistically significant differences between the two groups with p value log rank = 0.2, 0.8, 0.1, respectively. In multivariate analysis assessing SE, hilar control approach, hospital volume (HV), RENAL score, gender, Age, ECOG, EBL, BMI, and indication of NSS, age at surgery was associated with PSM (odds ratio [OR] 1.03 (95% CI 1.00–1.04), 0.02), whereas SE, HV, and type of hilar control approach were not predictive factors of PSM.


Hilar control approach seems to have no impact on PSM of RPN for RCC. Our findings were consistent with randomized trials.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. 1.

    Ljungberg B et al (2015) EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 67(5):913–924. https://doi.org/10.1016/j.eururo.2015.01.005

    Article  PubMed  Google Scholar 

  2. 2.

    Gill IS, Aron M, Gervais DA, Jewett MAS (2010) Small renal mass. N Engl J Med 362(7):624–634. https://doi.org/10.1056/NEJMcp0910041

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Campbell SC et al (2009) Guideline for management of the clinical T1 renal mass. J Urol 182(4):1271–1279. https://doi.org/10.1016/j.juro.2009.07.004

    Article  PubMed  Google Scholar 

  4. 4.

    Huang WC et al (2006) Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol 7(9):735–740. https://doi.org/10.1016/S1470-2045(06)70803-8

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Simone G, Ferriero M, Papalia R, Costantini M, Guaglianone S, Gallucci M (2013) Zero-ischemia minimally invasive partial nephrectomy. Curr Urol Rep 14(5):465–470. https://doi.org/10.1007/s11934-013-0359-0

    Article  PubMed  Google Scholar 

  6. 6.

    Thompson RH et al (2012) Renal function after partial nephrectomy: effect of warm ischemia relative to quantity and quality of preserved kidney. Urology 79(2):356–360. https://doi.org/10.1016/j.urology.2011.10.031

    Article  PubMed  Google Scholar 

  7. 7.

    Guillonneau B et al (2003) Laparoscopic partial nephrectomy for renal tumor: single center experience comparing clamping and no clamping techniques of the renal vasculature. J Urol 169(2):483–486. https://doi.org/10.1016/S0022-5347(05)63939-0

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Kutikov A, Uzzo RG (2009) The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182(3):844–853. https://doi.org/10.1016/j.juro.2009.05.035

    Article  PubMed  Google Scholar 

  9. 9.

    Zargar H et al (2015) The impact of extended warm ischemia time on late renal function after robotic partial nephrectomy. J Endourol 29(4):444–448. https://doi.org/10.1089/end.2014.0557

    Article  PubMed  Google Scholar 

  10. 10.

    Minervini A et al (2020) Impact of resection technique on perioperative outcomes and surgical margins after partial nephrectomy for localized renal masses: a prospective multicenter study. J Urol 203(3):496–504. https://doi.org/10.1097/JU.0000000000000591

    Article  PubMed  Google Scholar 

  11. 11.

    Volpe A et al (2015) Renal ischemia and function after partial nephrectomy: a collaborative review of the literature. Eur Urol 68(1):61–74. https://doi.org/10.1016/j.eururo.2015.01.025

    Article  PubMed  Google Scholar 

  12. 12.

    Mohapatra A, Potretzke A, Weaver J, Anderson B, Vetter J, Figenshau R (2017) Trends in the management of small renal masses: a survey of members of the Endourological Society. J Kidney Cancer VHL 4(3):10. https://doi.org/10.15586/jkcvhl.2017.82

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Garisto J et al (2018) Robotic versus open partial nephrectomy for highly complex renal masses: Comparison of perioperative, functional, and oncological outcomes. Urol Oncol 36(10):471.e1-471.e9. https://doi.org/10.1016/j.urolonc.2018.06.012

    Article  Google Scholar 

  14. 14.

    Thompson RH et al (2010) Every minute counts when the renal hilum is clamped during partial nephrectomy. Eur Urol 58(3):340–345. https://doi.org/10.1016/j.eururo.2010.05.047

    Article  PubMed  Google Scholar 

  15. 15.

    Volpe A et al (2014) Perioperative and renal functional outcomes of elective robot-assisted partial nephrectomy (RAPN) for renal tumours with high surgical complexity: RAPN for renal tumours with high surgical complexity. BJU Int 114(6):903–909. https://doi.org/10.1111/bju.12751

    Article  PubMed  Google Scholar 

  16. 16.

    Gill IS et al (2011) ‘Zero ischemia’ partial nephrectomy: novel laparoscopic and robotic technique. Eur Urol 59(1):128–134. https://doi.org/10.1016/j.eururo.2010.10.002

    Article  PubMed  Google Scholar 

  17. 17.

    Zhou L et al (2015) Selective versus hilar clamping during minimally invasive partial nephrectomy: a systematic review and meta-analysis. J Endourol 29(8):855–863. https://doi.org/10.1089/end.2014.0878

    Article  PubMed  Google Scholar 

  18. 18.

    Porpiglia F, Fiori C, Checcucci E, Amparore D, Bertolo R (2018) Hyperaccuracy three-dimensional reconstruction is able to maximize the efficacy of selective clamping during robot-assisted partial nephrectomy for complex renal masses. Eur Urol 74(5):651–660. https://doi.org/10.1016/j.eururo.2017.12.027

    Article  PubMed  Google Scholar 

  19. 19.

    Rod X et al (2016) Impact of ischaemia time on renal function after partial nephrectomy: a systematic review. BJU Int 118(5):692–705. https://doi.org/10.1111/bju.13580

    Article  PubMed  Google Scholar 

  20. 20.

    Bertolo R et al (2019) Off-clamp vs on-clamp robotic partial nephrectomy: Perioperative, functional and oncological outcomes from a propensity-score matching between two high-volume centers. Eur J Surg Oncol 45(7):1232–1237. https://doi.org/10.1016/j.ejso.2018.12.005

    Article  PubMed  Google Scholar 

  21. 21.

    Anderson BG et al (2019) Comparing off-clamp and on-clamp robot-assisted partial nephrectomy: a prospective randomized trial. Urology 126:102–109. https://doi.org/10.1016/j.urology.2018.11.053

    Article  PubMed  Google Scholar 

  22. 22.

    Bove P et al (2020) Deviation from the protocol of a randomized clinical trial comparing on-clamp versus off-clamp laparoscopic partial nephrectomy (CLOCK II laparoscopic study): a real-life analysis. J Urol. https://doi.org/10.1097/JU.0000000000001417

    Article  PubMed  Google Scholar 

  23. 23.

    T. A. G. (Italian G. for A. L.-E. Surgery) et al (2020) Safety of on- vs off-clamp robotic partial nephrectomy: per-protocol analysis from the data of the CLOCK randomized trial. World J Urol 38(5):1101–1108. https://doi.org/10.1007/s00345-019-02879-4

    Article  Google Scholar 

  24. 24.

    Antonelli A et al (2019) Predictors of the transition from off to on clamp approach during ongoing robotic partial nephrectomy: data from the CLOCK randomized clinical trial. J Urol 202(1):62–68. https://doi.org/10.1097/JU.0000000000000194

    Article  PubMed  Google Scholar 

  25. 25.

    Cacciamani GE et al (2019) Impact of renal hilar control on outcomes of robotic partial nephrectomy: systematic review and cumulative meta-analysis. Eur Urol Focus 5(4):619–635. https://doi.org/10.1016/j.euf.2018.01.012

    Article  PubMed  Google Scholar 

  26. 26.

    Larcher A et al (2019) The learning curve for robot-assisted partial nephrectomy: impact of surgical experience on perioperative outcomes. Eur Urol 75(2):253–256. https://doi.org/10.1016/j.eururo.2018.08.042

    Article  PubMed  Google Scholar 

  27. 27.

    Peyronnet B et al (2018) Impact of hospital volume and surgeon volume on robot-assisted partial nephrectomy outcomes: a multicentre study. BJU Int 121(6):916–922. https://doi.org/10.1111/bju.14175

    Article  PubMed  Google Scholar 

  28. 28.

    Dagenais J et al (2019) Variability in partial nephrectomy outcomes: does your surgeon matter? Eur Urol 75(4):628–634. https://doi.org/10.1016/j.eururo.2018.10.046

    Article  PubMed  Google Scholar 

  29. 29.

    Antonelli A et al (2019) On-clamp versus off-clamp robotic partial nephrectomy: a systematic review and meta-analysis. Urol J 86(2):52–62. https://doi.org/10.1177/0391560319847847

    Article  Google Scholar 

Download references



Author information



Corresponding author

Correspondence to Youness Ahallal.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (XLSX 12 KB)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Mellouki, A., Bentellis, I., Morrone, A. et al. Evaluation of oncological outcomes of robotic partial nephrectomy according to the type of hilar control approach (On-clamp vs Off-clamp), a multicentric study of the French network of research on kidney cancer—UROCCR 58-NCT03293563. World J Urol (2021). https://doi.org/10.1007/s00345-020-03558-5

Download citation


  • Hilar control approach
  • Kidney cancer
  • Oncological outcomes
  • Positive surgical margins
  • Robotic partial nephrectomy