Outcomes of Robot-assisted Partial Nephrectomy for Clinical T3a Renal Masses: A Multicenter Analysis.

Carcinoma, Renal Cell / pathology Humans Kidney Neoplasms / pathology Margins of Excision Nephrectomy / methods Retrospective Studies Robotics Treatment Outcome

Clinical T3a stage Outcomes Partial nephrectomy Renal cell carcinoma Robot-assisted surgery Trifecta

Journal

European urology focus

ISSN: 2405-4569

Titre abrégé: Eur Urol Focus

Pays: Netherlands

ID NLM: 101665661

Informations de publication

Date de publication:
Sep 2021

Historique:

received: 10 08 2020

revised: 08 10 2020

accepted: 26 10 2020

pubmed: 30 11 2020

medline: 14 4 2022

entrez: 29 11 2020

Statut: ppublish

Résumé

Use of partial nephrectomy (PN) in T3 renal cell carcinoma (RCC) is controversial. To evaluate quality outcomes of robot-assisted PN (RAPN) for clinical T3a renal masses (cT3aRM). This was a retrospective multicenter analysis of patients with cT3aN0M0 RCC who underwent RAPN. RAPN. The primary endpoint was a trifecta composite outcome of negative surgical margins, warm ischemia time (WIT) ≤25 min, and no perioperative complications. The optimal outcome was defined as achieving this trifecta and ≥90% preservation of the estimated glomerular filtration rate (eGFR) and no stage upgrading of chronic kidney disease. Multivariable analysis (MVA) identified risk factors associated with lack of the optimal outcome. Kaplan-Meier analysis was conducted for survival outcomes. Analysis was conducted for 157 patients (median follow-up 26 mo). The median tumor size was 7.0 cm (interquartile range [IQR] 5.0-7.8) and the median RENAL score was 9 (IQR 8-10). Median estimated blood loss (EBL) was 242 ml (IQR 121-354) and the median WIT was 19 min (IQR 15-25). A total of 150 patients (95.5%) had negative margins. Complications were noted in 25 patients (15.9%), with 4.5% having Clavien grade 3-5 complications. The median change in eGFR was 7 ml/min/1.72 m RAPN for select cT3a renal masses is feasible and safe, with acceptable quality outcomes. Further investigation is requisite to delineate the role of RAPN in cT3a RCC. Robot-assisted partial nephrectomy in patients with stage 3a kidney cancer provided acceptable survival, functional, and morbidity outcomes in the hands of experienced surgeons, and may be considered as an option when clinically indicated.

Sections du résumé

BACKGROUND BACKGROUND

Use of partial nephrectomy (PN) in T3 renal cell carcinoma (RCC) is controversial.

OBJECTIVE OBJECTIVE

To evaluate quality outcomes of robot-assisted PN (RAPN) for clinical T3a renal masses (cT3aRM).

DESIGN, SETTING, AND PARTICIPANTS METHODS

This was a retrospective multicenter analysis of patients with cT3aN0M0 RCC who underwent RAPN.

INTERVENTION METHODS

RAPN.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS METHODS

The primary endpoint was a trifecta composite outcome of negative surgical margins, warm ischemia time (WIT) ≤25 min, and no perioperative complications. The optimal outcome was defined as achieving this trifecta and ≥90% preservation of the estimated glomerular filtration rate (eGFR) and no stage upgrading of chronic kidney disease. Multivariable analysis (MVA) identified risk factors associated with lack of the optimal outcome. Kaplan-Meier analysis was conducted for survival outcomes.

RESULTS AND LIMITATIONS CONCLUSIONS

Analysis was conducted for 157 patients (median follow-up 26 mo). The median tumor size was 7.0 cm (interquartile range [IQR] 5.0-7.8) and the median RENAL score was 9 (IQR 8-10). Median estimated blood loss (EBL) was 242 ml (IQR 121-354) and the median WIT was 19 min (IQR 15-25). A total of 150 patients (95.5%) had negative margins. Complications were noted in 25 patients (15.9%), with 4.5% having Clavien grade 3-5 complications. The median change in eGFR was 7 ml/min/1.72 m

CONCLUSIONS CONCLUSIONS

RAPN for select cT3a renal masses is feasible and safe, with acceptable quality outcomes. Further investigation is requisite to delineate the role of RAPN in cT3a RCC.

PATIENT SUMMARY RESULTS

Robot-assisted partial nephrectomy in patients with stage 3a kidney cancer provided acceptable survival, functional, and morbidity outcomes in the hands of experienced surgeons, and may be considered as an option when clinically indicated.

Identifiants

DOI: 10.1016/j.euf.2020.10.011 PMID: 33249089

pubmed: 33249089

pii: S2405-4569(20)30295-9

doi: 10.1016/j.euf.2020.10.011

pii:

doi:

Types de publication

Journal Article Multicenter Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

Pagination

1107-1114