Historically, open techniques have been favored over minimally invasive approaches for complex surgeries. We aimed to identify differences in perioperative outcomes, surgical footprints, and complication rates in patients undergoing either open or robotic reoperative partial nephrectomies (RePN).
A retrospective review of patients undergoing RePN was performed. Patients were assigned cohorts based on current and prior surgical approaches: open after open, open after minimally invasive surgery (MIS), robotic after open, and robotic after MIS cohorts. Perioperative outcomes were compared among cohorts. Factors contributing to complications were assessed.
A total of 192 patients underwent RePN, including 103 in the open after open, 10 in the open after MIS, 47 in the robotic after open, and 32 in the robotic after MIS cohorts. The overall and major complication (grade ≥3) rates were 65% and 19%, respectively. The number of blood transfusions, overall complications, and major complications were significantly lower in robotic compared to open surgical cohorts. On multivariate analysis, the robotic approach was protective against major complications (OR: 0.3, p=0.02) and estimated blood loss was predictive (OR: 1.03, p=0.004). Prior surgical approach was not predictive for major complications.
RePN is feasible using both open and robotic approaches. While the robotic approach was independently associated with fewer major complications, prior approach was not, implying that prior surgical approaches are less important to perioperative outcomes and in contributing to the overall surgical footprint.
The Journal of urology. 2021 Apr 27 [Epub ahead of print]
Sandeep Gurram, Nicholas A Friedberg, Chirag Gordhan, Winston Li, Michael A Ahdoot, Jillian Egan, Nitin K Yerram, Gennady Bratslavsky, Adam R Metwalli, W Marston Linehan, Mark W Ball
Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institute of Health, Bethesda, Maryland.