Outcomes in robot-assisted partial nephrectomy for imperative vs elective indications.
Aged
Aged, 80 and over
Blood Loss, Surgical
Blood Transfusion
Databases, Factual
Elective Surgical Procedures
Female
Glomerular Filtration Rate
Humans
Kidney Neoplasms
/ surgery
Male
Margins of Excision
Middle Aged
Nephrectomy
/ adverse effects
Operative Time
Postoperative Complications
/ etiology
Propensity Score
Retrospective Studies
Robotic Surgical Procedures
/ adverse effects
Warm Ischemia
imperative indications
partial nephrectomy
renal cancer
robot-assisted
Journal
BJU international
ISSN: 1464-410X
Titre abrégé: BJU Int
Pays: England
ID NLM: 100886721
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
revised:
10
08
2021
received:
03
02
2021
accepted:
21
08
2021
pubmed:
28
8
2021
medline:
18
1
2022
entrez:
27
8
2021
Statut:
ppublish
Résumé
To assess and compare peri-operative outcomes of patients undergoing robot-assisted partial nephrectomy (RAPN) for imperative vs elective indications. We retrospectively reviewed a multinational database of 3802 adults who underwent RAPN for elective and imperative indications. Laparoscopic or open partial nephrectomy (PN) were excluded. Baseline data for age, gender, body mass index, American Society of Anaesthesiologists score and PADUA score were examined. Patients undergoing RAPN for an imperative indication were matched to those having surgery for an elective indication using propensity scores in a 1:3 ratio. Primary outcomes included organ ischaemic time, operating time, estimated blood loss (EBL), rate of blood transfusions, Clavien-Dindo complications, conversion to radical nephrectomy (RN) and positive surgical margin (PSM) status. After propensity-score matching for baseline variables, a total of 304 patients (76 imperative vs 228 elective indications) were included in the final analysis. No significant differences were found between groups for ischaemia time (19.9 vs 19.8 min; P = 0.94), operating time (186 vs 180 min; P = 0.55), EBL (217 vs 190 mL; P = 0.43), rate of blood transfusions (2.7% vs 3.7%; P = 0.51), or Clavien-Dindo complications (P = 0.31). A 38.6% (SD 47.9) decrease in Day-1 postoperative estimated glomerular filtration rate was observed in the imperative indication group and an 11.3% (SD 45.1) decrease was observed in the elective indication group (P < 0.005). There were no recorded cases of permanent or temporary dialysis. There were no conversions to RN in the imperative group, and seven conversions (5.6%) in the elective group (P = 0.69). PSMs were seen in 1.4% (1/76) of the imperative group and in 3.3% of the elective group (7/228; P = 0.69). We conclude that RAPN is feasible and safe for imperative indications and demonstrates similar outcomes to those achieved for elective indications.
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
30-35Informations de copyright
© 2021 The Authors BJU International © 2021 BJU International Published by John Wiley & Sons Ltd.
Références
Leslie S, Goh AC, Gill IS. Partial nephrectomy-contemporary indications, techniques and outcomes. Nat Rev Urol 2013; 10: 275-83
Ljungberg B, Albiges L, Abu-Ghanem Y et al. European association of urology guidelines on renal cell carcinoma: The 2019 update. Eur Urol 2019; 75: 799-810
Campbell S, Uzzo RG, Allaf ME et al. Renal mass and localized renal cancer: AUA Guideline. J Urol 2017; 198: 520-9
Coffin G, Hupertan V, Taksin L et al. Impact of elective versus imperative indications on oncologic outcomes after open nephron-sparing surgery for the treatment of sporadic renal cell carcinomas. Ann Surg Oncol 2011; 18: 1151-7
Heinze A, Larcher A, Umari P et al. Assessing perioperative, functional and oncological outcomes of patients with imperative versus elective indications for robot-assisted partial nephrectomy: Results from a high-volume center. Int J Urol 2018; 25: 826-31
Gill IS, Kavoussi LR, Lane BR et al. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 2007; 178: 41-6
Xia L, Wang X, Xu T, Guzzo TJ. Systematic review and meta-analysis of comparative studies reporting perioperative outcomes of robot-assisted partial nephrectomy versus open partial nephrectomy. J Endourol 2017; 31: 893-909
Tan JL, Frydenberg M, Grummet J et al. Comparison of perioperative, renal and oncologic outcomes in robotic-assisted versus open partial nephrectomy. ANZ J Surg 2018; 88: E194-9
Takagi T, Kondo T, Tachibana H et al. Robot-assisted laparoscopic versus open partial nephrectomy in patients with chronic kidney disease: A propensity score-matched comparative analysis of surgical outcomes. Int J Urol 2017; 24: 505-10
Zargar H, Bhayani S, Allaf ME et al. Comparison of perioperative outcomes of robot-assisted partial nephrectomy and open partial nephrectomy in patients with a solitary kidney. J Endourol 2014; 28: 1224-30
Rogers CG, Singh A, Blatt AM, Linehan WM, Pinto PA. Robotic partial nephrectomy for complex renal tumors: surgical technique. Eur Urol 2008; 53: 514-21
Long JA, Bernhard JC, Bigot P et al. Partial nephrectomy versus ablative therapy for the treatment of renal tumors in an imperative setting. World J Urol 2017; 35: 649-56
Ghani KR, Sukumar S, Sammon JD, Rogers CG, Trinh QD, Menon M. Practice patterns and outcomes of open and minimally invasive partial nephrectomy since the introduction of robotic partial nephrectomy: results from the nationwide inpatient sample. J Urol 2014; 191: 907-12
Clavien PA, Barkun J, De Oliveira ML et al. The clavien-dindo classification of surgical complications: Five-year experience. Ann Surg 2009; 250: 187-96
Panumatrassamee K, Kaouk JH, Autorino R et al. Cryoablation versus minimally invasive partial nephrectomy for small renal masses in the solitary kidney: Impact of approach on functional outcomes. J Urol 2013; 189: 818-22
Peyronnet B, Seisen T, Oger E et al. Comparison of 1800 robotic and open partial nephrectomies for renal tumors. Ann Surg Oncol 2016; 23: 4277-83
Long JA, Lee B, Eyraud R et al. Robotic partial nephrectomy: Imperative vs elective indications. Urology 2012; 80: 833-7
Patel HD, Mullins JK, Pierorazio PM et al. Trends in renal surgery: Robotic technology is associated with increased use of partial nephrectomy. J Urol 2013; 189: 1229-35
Komninos C, Shin TY, Tuliao P et al. Robotic partial nephrectomy for completely endophytic renal tumors: Complications and functional and oncologic outcomes during a 4-year median period of follow-up. Urology 2014; 84: 1367-73
Ficarra V, Minervini A, Antonelli A et al. A multicentre matched-pair analysis comparing robot-assisted versus open partial nephrectomy. BJU Int 2014; 113: 936-41
Garisto J, Bertolo R, Dagenais J et al. Robotic versus open partial nephrectomy for highly complex renal masses: Comparison of perioperative, functional, and oncological outcomes. Urol Oncol 2018; 36: 471.e1-471.e9
Choi JE, You JH, Kim DK, Rha KH, Lee SH. Comparison of perioperative outcomes between robotic and laparoscopic partial nephrectomy: A systematic review and meta-analysis. Euro Urol 2015; 67: 891-901
Guillotreau J, Yakoubi R, Long JA et al. Robotic partial nephrectomy for small renal masses in patients with pre-existing chronic kidney disease. Urology 2012; 80: 845-51
Dalela D, Barod R, Gandaglia G et al. Outcomes of robot-assisted partial nephrectomy in patients with complex renal tumours and pre-existing chronic kidney disease in a multi-institutional, multinational database. Eur Urol Suppl 2016; e412. https://doi.org/10.1016/S1569-9056(16)60414-1
Arora S, Abaza R, Adshead JM et al. ‘Trifecta’ outcomes of robot-assisted partial nephrectomy in solitary kidney: a Vattikuti Collective Quality Initiative (VCQI) database analysis. BJU Int 2018; 121: 119-23
Schiavina R, Mari A, Bianchi L et al. Predicting positive surgical margins in partial nephrectomy: A prospective multicentre observational study (the RECORd 2 project). Eur J Surg Oncol 2020; 46: 1353-9
Borghesi M, Brunocilla E, Schiavina R, Martorana G. Positive surgical margins after nephron-sparing surgery for renal cell carcinoma: Incidence, clinical impact, and management. Clin Genitourinary Cancer 2013; 11: 5-9
Thompson RH, Lane BR, Lohse CM et al. Renal function after partial nephrectomy: effect of warm ischemia relative to quantity and quality of preserved kidney. Urology 2012; 79: 356-60
Kural AR, Demirkesen O, Onal B et al. Outcome of nephron-sparing surgery: elective versus imperative indications. Urol Int 2003; 71: 190-6
Bradshaw AW, Autorino R, Simone G et al. Robotic partial nephrectomy vs minimally invasive radical nephrectomy for clinical T2a renal mass: a propensity score-matched comparison from the ROSULA (Robotic Surgery for Large Renal Mass) Collaborative Group. BJU Int 2020; 126: 114-23
Lawrentschuk N. Urology trial success - get urologists involved early. BJU Int 2019; 124: 4