Five-year Oncologic Outcomes After Transperitoneal Robotic Partial Nephrectomy for Renal Cell Carcinoma

Partical nephrectomy (PN) is the golden standard of care for clinical T1 renal masses, with both open and laparoscopic PN as current procedures for renal tumors. The Da Vinci robot was developed to facilitate complex urologic procedures, making them easier due to its wrist articulation, three-dimensional magnified vision, and better ergonomics for the surgeons. Previous studies have already showed that robot-assisted partial nephrectomy (RPN) achieved similar perioperative outcomes when compared to open technique. However, no long-term outcomes for RPN have been studied. Thus, the goal of this study is to report long-term oncologic outcomes in patients undergoing RPN for renal cell carcinoma (RCC).

The investigators conducted a retrospective analysis of the prospective RPN database for all consecutive patients undergoing surgery between June 2006 and March 2010. Overall survival (OS), cancer-free survival (CFS), and cancer-specific survival (CSS) were evaluated using Kaplan-Meier analysis. Analyses were performed using SPSS version 21, and significance level was set at p<0.05.

In the study, 110 patients undergoing 115 RPNs were selected. The median RENAL score was 7 (IQR 6-9), median operative time was 180 min (IQR 15-215), and median EBL was 200 ml (IQR 11-350). 13 cases had zero ischemia, and median WIT for the remaining patients was 20 min (IQR 16-27). The final results showed that 5-yr OS, CFS, and CSS were 91.1% (95% confidence interval [CI] 87.2-94.9%), 97.8% (95% CL 95.9-99.7%), and 97.8% (95% CI 95.9-99.7%), respectively. ACCI was the only factor associated with a higher risk of overall mortality (OR 1.67, p = 0.006). Finally, median postoperative estimated GFR was 69.6 ml/min/1.73 m2, and median GFR preservation after RPN was 88% (IQR 75-98%).

This is the first study to report 5-yr oncologic outcomes of RPN for RCC during long-term follow up. The results of the study demonstrated excellent OS, CS, and CSS, which are comparable to previous reports for different NSS approaches. Their findings that ACCI was the only predictive factor for overall mortality suggests that AS can play an important role in the treatment of SRMs in elderly and ill-patients. The authors acknowledges that limitations of the study, which includes its retrospective design, high surgical volume at a single institution, and selection bias which could have limit the generalizability of the results. Future studies with follow-up up data for RPN in less selected series with larger and more complex tumors are needed for further analysis.

Authors: Hiury S. Andrade, Homayoun Zargar, Peter A. Caputo, Oktay Akca, Onder Kara, Daniel Ramirez, Georges-Pascal Haber, Robert J. Stein, Jihad H. Kaouk *

Affiliations: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA

Read the Abstract

Reference:

Campbell SC, Novick AC, Belldegrun A, et al. Guideline for management of the clinical T1 renal mass. J Urol 2009;182:1271–9.

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.

Login