The IRON Study: Investigation of Robot-assisted Versus Open Nephron-sparing Surgery.

Complications Open partial nephrectomy Perioperative outcomes Robot-assisted partial nephrectomy Robotic surgery Urological procedures

Journal

European urology open science
ISSN: 2666-1683
Titre abrégé: Eur Urol Open Sci
Pays: Netherlands
ID NLM: 101771568

Informations de publication

Date de publication:
Mar 2023
Historique:
accepted: 08 12 2022
entrez: 6 3 2023
pubmed: 7 3 2023
medline: 7 3 2023
Statut: epublish

Résumé

Current literature does not provide large-scale data regarding clinical outcomes of robot-assisted (RAPN) versus open (OPN) partial nephrectomy. Moreover, data assessing predictors of long-term oncologic outcomes after RAPN are scarce. To compare perioperative, functional, and oncologic outcomes of RAPN versus OPN, and to investigate the predictors of oncologic outcomes after RAPN. This study included 3467 patients treated with OPN ( The study outcomes were short-term postoperative, functional, and oncologic outcomes. Regression models investigated the effect of surgical approach (open vs Robot assisted) on study outcomes, and interaction tests were used for subgroup analyses. Propensity score matching for demographic and tumor characteristics was used in sensitivity analyses. Multivariable Cox-regression analyses identified predictors of oncologic outcomes after RAPN. Baseline characteristics were similar between patients receiving RAPN and OPN, with only few differences. After adjusting for confounding, RAPN was associated with lower odds of intraoperative (odds ratio [OR]: 0.39, 95% confidence interval [CI]: 0.22, 0.68) and Clavien-Dindo ≥2 postoperative (OR: 0.29, 95% CI: 0.16, 0.50) complications (both While cancer control and long-term renal function did not differ between RAPN and OPN, we found that the intra- and postoperative morbidity-especially in terms of complications-was lower after RAPN than after OPN. Our predictive models allow surgeons to estimate the risk of adverse oncologic outcomes after RAPN, with relevant implications for preoperative counseling and follow-up after surgery. In this comparative study on robotic versus open partial nephrectomy, functional and oncologic outcomes were similar between the two techniques, with lower morbidity-especially in terms of complications-for robot-assisted surgery. The assessment of prognosticators for patients receiving robot-assisted partial nephrectomy may help in preoperative counseling and provides relevant data to tailor postoperative follow-up.

Sections du résumé

Background UNASSIGNED
Current literature does not provide large-scale data regarding clinical outcomes of robot-assisted (RAPN) versus open (OPN) partial nephrectomy. Moreover, data assessing predictors of long-term oncologic outcomes after RAPN are scarce.
Objective UNASSIGNED
To compare perioperative, functional, and oncologic outcomes of RAPN versus OPN, and to investigate the predictors of oncologic outcomes after RAPN.
Design setting and participants UNASSIGNED
This study included 3467 patients treated with OPN (
Outcome measurements and statistical analysis UNASSIGNED
The study outcomes were short-term postoperative, functional, and oncologic outcomes. Regression models investigated the effect of surgical approach (open vs Robot assisted) on study outcomes, and interaction tests were used for subgroup analyses. Propensity score matching for demographic and tumor characteristics was used in sensitivity analyses. Multivariable Cox-regression analyses identified predictors of oncologic outcomes after RAPN.
Results and limitations UNASSIGNED
Baseline characteristics were similar between patients receiving RAPN and OPN, with only few differences. After adjusting for confounding, RAPN was associated with lower odds of intraoperative (odds ratio [OR]: 0.39, 95% confidence interval [CI]: 0.22, 0.68) and Clavien-Dindo ≥2 postoperative (OR: 0.29, 95% CI: 0.16, 0.50) complications (both
Conclusions UNASSIGNED
While cancer control and long-term renal function did not differ between RAPN and OPN, we found that the intra- and postoperative morbidity-especially in terms of complications-was lower after RAPN than after OPN. Our predictive models allow surgeons to estimate the risk of adverse oncologic outcomes after RAPN, with relevant implications for preoperative counseling and follow-up after surgery.
Patient summary UNASSIGNED
In this comparative study on robotic versus open partial nephrectomy, functional and oncologic outcomes were similar between the two techniques, with lower morbidity-especially in terms of complications-for robot-assisted surgery. The assessment of prognosticators for patients receiving robot-assisted partial nephrectomy may help in preoperative counseling and provides relevant data to tailor postoperative follow-up.

Identifiants

DOI: 10.1016/j.euros.2022.12.017 PMID: 36874602 PMC: PMC9974968
pubmed: 36874602
doi: 10.1016/j.euros.2022.12.017
pii: S2666-1683(23)00012-5
pmc: PMC9974968
doi:

Types de publication

Journal Article

Langues

eng

Pagination

71-77

Informations de copyright

© 2023 The Authors.

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Auteurs

Carlo Andrea Bravi (CA)

Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium.
ORSI Academy, Ghent, Belgium.

Giuseppe Rosiello (G)

Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.

Elio Mazzone (E)

Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.

Andrea Minervini (A)

Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy.

Andrea Mari (A)

Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy.

Fabrizio Di Maida (F)

Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy.

Karim Bensalah (K)

Department of Urology, University of Rennes, Rennes, France.

Benoit Peyronnet (B)

Department of Urology, University of Rennes, Rennes, France.

Zine-Eddine Khene (ZE)

Department of Urology, University of Rennes, Rennes, France.

Riccardo Schiavina (R)

Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.

Lorenzo Bianchi (L)

Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.

Alexandre Mottrie (A)

Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium.
ORSI Academy, Ghent, Belgium.

Geert De Naeyer (G)

Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium.

Alessandro Antonelli (A)

Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy.

Maria Furlan (M)

Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy.

Koon Ho Rha (KH)

Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.

Ahmad Almujalhem (A)

Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.

Ithaar Derweesh (I)

Department of Urology, Moores UCSD Cancer Center, University of California San Diego School of Medicine, San Diego, CA, USA.

Aaronw Bradshaw (A)

Department of Urology, Moores UCSD Cancer Center, University of California San Diego School of Medicine, San Diego, CA, USA.

Jihak Kaouk (J)

Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.

Guilherme Sawczyn (G)

Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.

Riccardo Bertolo (R)

Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.

Alberto Breda (A)

Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain.

Francesco Montorsi (F)

Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.

Umberto Capitanio (U)

Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.

Alessandro Larcher (A)

Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.

Classifications MeSH