A hilar location for a renal tumour is sometimes viewed as a limiting factor for safe partial nephrectomy. Our aim was to evaluate perioperative, oncological, and functional outcomes of robot-assisted partial nephrectomy (RAPN) for hilar tumours (RAPN-H) in comparison to RAPN for nonhilar tumours (RAPN-NH).
We conducted an observational, multicentre cohort study using prospectively collected data from the French Research Network on Kidney Cancer (UroCCR). The registry includes data for 3551 patients who underwent RAPN for localised or locally advanced renal masses between 2010 and 2023 in 29 hospitals in France. We studied the impact of a hilar location on surgery, postoperative renal function, tumour characteristics, and survival. We also compared rates of trifecta achievement (warm ischaemia time [WIT] <25 min, negative surgical margins, and no perioperative complications) between the groups. Finally, we performed a subgroup analysis of RAPN without vascular clamping. Variables were compared in univariable analysis and using multivariable linear, logistic, and Cox proportional-hazards models adjusted for relevant patient and tumour covariates.
The analytical population included 3451 patients, of whom 2773 underwent RAPN-NH and 678 underwent RAPN-H. Longer WIT (β = 2.4 min; p < 0.01), longer operative time (β = 11.4 min; p < 0.01) and a higher risk of postoperative complications (odds ratio 1.33; p = 0.05) were observed in the hilar group. Blood loss, the perioperative transfusion rate, postoperative changes in the estimated glomerular filtration rate, and trifecta achievement rates were comparable between the groups (p > 0.05). At mean follow-up of 31.9 mo, there was no significant difference in recurrence-free survival (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.58-1.2; p = 0.3), cancer-specific survival (HR 1.1, 95% CI 0.48-2.6; p = 0.79), or overall survival (HR 0.89, 95% CI 0.52-1.53; p = 0.69).
Patient and tumour characteristics rather than just hilar location should be the main determinants of the optimal surgical strategy for hilar tumours.
We found that kidney tumours located close to major kidney blood vessels led to a longer operation and a higher risk of complications during robot-assisted surgery to remove the tumour. However, tumours in these locations were not related to a higher risk of kidney function loss, cancer recurrence, or death.
European urology oncology. 2024 Jun 26 [Epub ahead of print]
Julien Sarkis, Cecile M Champy, Nicolas Doumerc, Franck Bruyere, Morgan Rouprêt, Nicolas Branger, Louis Surlemont, Constance Michel, Thibaut Waeckel, Bastien Parier, Jean-Baptiste Beauval, Pierre Bigot, Hervé Lang, Maxime Vallee, Julien Guillotreau, Jean-Jacques Patard, Clément Sarrazin, Stéphane de Vergie, Olivier Belas, Romain Boissier, Richard Mallet, Frédéric Panthier, Fayek Taha, Quentin-Côme Le Clerc, Lionel Hoquetis, François Audenet, Louis Vignot, Philippe Paparel, Alexis Fontenil, Jean-Christophe Bernhard, Alexandre Ingels, Comité Cancer de l’Association Française d’Urologie
Urology Department, Grand Hôpital de l'Est Francilien, Meaux, France. Electronic address: ., Urology Department, Henri Mondor University Hospital, AP-HP, Creteil, France; Inserm Clinical Investigation Centre 1430, Henri Mondor University Hospital, AP-HP, Creteil, France., Urology Department, CHU Rangueil, Toulouse, France., Urology Department, CHRU Tours, Tours, France., Urology Department, CHU La Pitié Salpêtrière, AP-HP Paris, France., Urology Department, Institut Paoli Calmettes, Marseille, France., Urology Department, CHU Rouen, Rouen, France., Urology Department, Hôpital Privé St. Joseph, Paris, France., Urology Department, CHU Caen, Caen, France., Urology Department, Hôpital Bicêtre, AP-HP Paris, France., Urology Department, Clinique La Croix du Sud, Toulouse, France., Urology Department, CHU Angers, Angers, France., Urology Department, CHRU Strasbourg, Strasbourg, France., Urology Department, CHU Poitiers, Poitiers, France., Urology Department, Clinique Pasteur, Toulouse, France., Urology Department, CH Mont-de-Marsan, Mont-de-Marsan, France., Urology Department, CHU Grenoble, Grenoble, France., Urology Department, CHU Nantes, Nantes, France., Pôle Santé Sud, Le Mans, France., Aix Marseille Université, Service de Chirurgie urologique et de Transplantation rénale, CHU Conception, AP-HM, Marseille, France., Urology Department, Polyclinique Francheville, Périgueux, France., Urology Department, Hôpital Tenon, AP-HP Paris, France., Urology Department, CHU Reims, Reims, France., Clinique Santé Atlantique, Nantes, France., Clinique Nantes Atlantis, Saint-Herblain, France., Urology Department, Hôpital Européen Georges Pompidou, Paris, France., Urology Department, CHU Nice, Nice, France., Urology Department, Lyon Sud, Hospices Civils de Lyon, Lyon, France., Urology Department, CHU Nîmes, Nîmes, France., Urology Department CHU Bordeaux, Bordeaux, France.