To assess and compare perioperative outcomes of patients undergoing robotic-assisted partial nephrectomy (RAPN) for imperative versus elective indications.
We retrospectively reviewed a multinational database of 3,802 adult patients who underwent RAPN for elective and imperative indications. Laparoscopic or open PN were excluded. Baseline data for age, gender, BMI, ASA 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, operative time, estimated blood loss, rate of blood transfusions, Clavien-Dindo complications, conversion to radical nephrectomy (RN) and positive surgical margins.
After propensity score matching for baseline variables, a total of 304 patients (76 imperative vs 228 non-imperative indications) were included in the final analysis. No significant differences were found between groups for ischaemic time (19.9min vs 19.8min, p=0.94), operative time (186min vs 180min, p=0.55), estimated blood loss (217mL vs 190mL, 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 post-operative eGFR was seen in the imperative indication group and a 11.3% (SD 45.1) decrease in eGFR seen in the elective indications group, p<0.005; no recorded cases of permanent or temporary dialysis were seen. There were no conversions to RN in the imperative group and 5.6% (n=7) conversions in the non-imperative group (p=0.69). Positive surgical margins were seen in 1.4% (1/76) of the imperative group and 3.3% of the non-imperative group (7/228), p=0.69.
RAPN is feasible and safe for imperative indications and demonstrates similar outcomes to elective indications.
BJU international. 2021 Aug 27 [Epub ahead of print]
J Tan, N Sathianathen, M Cumberbatch, P Dasgupta, A Mottrie, R Abaza, K H Rha, T B Yuvaraja, D J Parekh, U Capitanio, R Ahlawat, S Rawal, N M Buffi, A Sivaraman, K K Maes, G Gautham, F Porpiglia, L Turkeri, M Bhandari, B Challacombe, J Porter, C Rogers, D Moon
Peter MacCallum Cancer Centre, Division of Cancer Surgery, Genitourinary Oncology, Melbourne, Australia., King's College, DMRC Centre of Transplantation, London, United Kingdom., ORSI Academy, Dept of Urology, Melle, Belgium., Dublin Methodist Hospital, Dept of Urology, Ohio, United States of America., Yonsei University Health System, Dept of Urology, Seoul, South Korea., Kokilaben Dhirubhai Ambani Hospital, Dept of Urology, Mumbai, India., University of Miami Health System, Dept of Urology, Miami, United States of America., San Raffaele Hospital, Milan, Italy, Dept of Urology, Milan, Italy., Medanta The Medicity Hospital, Dept of Urology, New Delhi, India., Rajiv Gandhi Cancer Institute and Research Centre, Dept of Urology, New Delhi, India., Humanitas Research hospital, Dept of Urology, Milan, Italy., Apollo Hospitals, Dept of Urology, Chennai, India., Center for Robotic and Minimally Invasive Surgery, Hospital Da Luz, Dept of Urology, Luz Sáude, Portugal., Max Institute of Cancer Care, Max Hospital, Dept of Urology, New Delhi, India., San Luigi Gonzaga Hospital of Orbassano, Dept of Urology, Turin, Italy., Acıbadem Hospitals Group, Dept of Urology, Istanbul, Turkey., Vattikuti Foundation, Dept of Urology, Detroit, United States of America., Guys and St, Thomas' Hospital, London, United Kingdom., Swedish Medical Centre, Seattle, WA, USA., Henry Ford Hospital, Detroit, MI, USA.