Robot-assisted partial nephrectomy (RAPN) has become widely used for treatment of renal cell carcinoma and it is expanding in the field of complex renal masses. The aim of this systematic review was to analyze outcomes of RAPN for completely endophytic renal masses, large tumors (cT2-T3), renal cell carcinoma in solitary kidney, recurrent tumors, completely endophytic and hilar masses, and simultaneous and multiple tumors.
A comprehensive search in the PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases was performed in December 2022 for English language papers. The primary endpoint was to evaluate the role of RAPN in the setting of each category of complex renal masses considered. The secondary endpoint was to evaluate the surgical and functional outcomes.
After screening 1250 records, 43 full-text manuscripts were selected, comprising over 8500 patients. Twelve and thirteen studies reported data for endophytic and hilar renal masses, respectively. Five and three studies reported outcomes for cT2-T3 and solitary kidney patients, respectively. Four studies focused on redo-RAPN for recurrent tumors. Two studies investigated simultaneous bilateral renal masses and five reports focused on multiple tumor excision in ipsilateral kidney.
Over the past decade, evidence supporting the use of RAPN for the most challenging nephron-sparing surgery indications has continuously grown. Although limitations remain including study design and lack of detailed long-term functional and oncological outcomes, the adoption of RAPN for the included advanced indications is associated with favorable surgical outcomes with good preservation of renal function without compromising the oncological result. Certainly, a higher likelihood of complication might be expected when facing extremely challenging cases. However, none of these indications should be considered per se an exclusion criterion for performing RAPN. Ultimately, a risk-adapted approach should be employed.
Asian journal of urology. 2023 Aug 01 [Epub]
Savio Domenico Pandolfo, Clara Cerrato, Zhenjie Wu, Antonio Franco, Francesco Del Giudice, Alessandro Sciarra, Paolo Verze, Giuseppe Lucarelli, Ciro Imbimbo, Sisto Perdonà, Edward E Cherullo, Francesco Porpiglia, Ithaar H Derweesh, Riccardo Autorino
Department of Urology, Rush University Medical Center, Chicago, IL, USA., Department of Urology, University of Verona, Verona, Italy., Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China., Department of Maternal-Infant and Urologic Sciences, La Sapienza University, Policlinico Umberto I Hospital, Rome, Italy., Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, Fisciano, Italy., Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy., Department of Neurosciences, Reproductive Sciences and Odontostomatology, "Federico II" University, Naples, Italy., Department Uro-Gynecology, IRCCS G. Pascale Foundation, Naples, Italy., Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy., Department of Urology, University of California San Diego, La Jolla, CA, USA.