OBJECTIVE: To evaluate the perioperative, postoperative and functional outcomes of robot-assisted partial nephrectomy (RAPN) for renal tumors with high surgical complexity at a large volume centre.
PATIENTS AND METHODS: Perioperative and functional outcomes of RAPNs for renal tumors with a PADUA score ≥10 performed at our institution between September 2006 and December 2012 were collected in a prospectively maintained database and analysed. Surgical complications were graded according to the Clavien-Dindo classification. Serum creatinine and estimated glomerular filtration rate (eGFR) were assessed at the third postoperative day and 3-6 months after surgery.
RESULTS: Forty-four RAPN for renal tumors with PADUA score ≥10 were included in the analysis. Twenty-three tumors (52.3%) were cT1b. Median operative time, estimated blood loss and warm ischemia time were 120 minutes (IQR 94-132, range 60-230), 150 ml (IQR 80-200, range 25-1200) and 16 minutes (IQR 13.8-18, range 5-35), respectively. Two intraoperative complications occurred (4.5%): one inferior vena caval injury and one bleeding from the renal bed, which were both managed robotically. Postoperative complications were observed in 10 cases (22.7%), of whom 4 (9.1%) were high Clavien grade, including two bleedings that required percutaneous embolization, one urinoma that resolved with ureteral stenting and one bowel occlusion managed with laparoscopic adhesiolysis. Two patients (4.5%) had positive surgical margins and were followed expectantly with no radiological recurrence at an average follow-up of 23 months. Mean serum creatinine levels were significantly increased after surgery (121.1 vs. 89.3 μmol/L; p=0.001), but decreased over time, without significant differences with the preoperative values at 6 months follow-up (96.4 vs. 89.3 μmol/L; p=0.09). The same trend was observed for eGFR.
CONCLUSION: In experienced hands RAPN for renal tumors with PADUA score ≥10 is feasible with short warm ischemia time, acceptable major complication rate and good long-term renal functional outcomes. A slightly higher risk of positive surgical margins can be expected due to the high surgical complexity of these lesions. The robotic technology allows a safe expansion of the indications of minimally invasive partial nephrectomy to anatomically very challenging renal lesions in referral centres.
Written by:
Volpe A, Garrou D, Amparore D, De Naeyer G, Porpiglia F, Ficarra V, Mottrie A. Are you the author?
Division of Urology, O.L.V. Vattikuti Robotic Surgery Institute, Aalst, Belgium; Division of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy.
Reference: BJU Int. 2014 Mar 27. Epub ahead of print.
doi: 10.1111/bju.12751
PubMed Abstract
PMID: 24673750
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