427 A multicenter matched-pair analysis comparing robot-assisted versus open partial nephrectomy

Abstract

ObjectiveTo compare the perioperative, pathological and functional outcomes in two contemporary, large series of patients in different institutions and who underwent open partial nephrectomy (OPN) or robot-assisted PN (RAPN) for suspected renal tumours. Patients and MethodsThis was a retrospective, multicentre, international, matched-pair analysis comparing patients who underwent RAPN or OPN for suspected renal cell carcinoma.Data on patients who underwent OPN were extracted by an Italian observational registry collecting data from 19 different centres.Data on patients who received RAPN were extracted from a multicentre, international database collecting cases treated in four high-volume referral centres of robotic surgery.The matching was in a 1:1 ratio for the surgical approach and included 200 patients in each arm. ResultsThe mean warm ischaemia time was shorter in the OPN group than in the RAPN group, at a mean (SD) of 15.4 (5.9) vs 19.2 (7.3) min (P < 0.001).Conversely, the median (interquartile range) estimated blood loss was 150 (100-300) mL in the OPN group and 100 (50-150) mL in the RAPN group (P < 0.001).There were no differences in operating time (P = 0.18) and the intraoperative complication rate (P = 0.31) between the approaches.Postoperative complications were recorded in 43 (21.5%) patients who underwent OPN and in 28 (14%) who received RAPN (P = 0.02). Moreover, major complications (grade 3-4) were reported in nine (4.5%) patients after OPN and in nine (4.5%) after RAPN.Positive margins were detected in nine (5.5%) patients after OPN and in nine (5.7%) after RAPN (P = 0.98). The mean (SD) 3-month estimated glomerular filtration rate declined by 16.6 (18.1) mL/min from the preoperative value in the OPN group and by 16.4 (22.9) mL/min in the RAPN group (P = 0.28). ConclusionRAPN can achieve equivalent perioperative, early oncological and functional outcomes as OPN. Moreover, RAPN is a less invasive approach, offering a lower risk of bleeding and postoperative complications than OPN.

A Prospective, Multicenter Evaluation of Predictive Factors for Positive Surgical Margins After Nephron-Sparing Surgery for Renal Cell Carcinoma: The RECORd1 Italian Project

“…In a recent matched-pair analysis comparing open and robot-assisted PNs from 23 centers, Ficarra et al found no significant difference in PSM rate among open (5.5%) and robot-assisted (5.7%) PNs (P ¼ .98). 16 Similarly, Springer and coworkers, showing results from a retrospective singleinstitutional study of 340 open and laparoscopic PNs for cT1 RCC, found comparable incidence of PSMs between the 2 groups (1.7% vs. 1.2%; P ¼ .09). 24 It appears still controversial whether the age at the time of surgery could be a predictor of PSMs.…”

“…SE), appear to be unrelated to margins status, according to the largest currently available evidence. 7,[14][15][16][17][18] We aimed to evaluate the predictors of PSM after NSS for RCC in one of the largest available prospective multi-institutional studies.…”

The Impact of Body Mass Index on Renal Functional Outcomes Following Minimally Invasive Partial Nephrectomy

“…The advantages of MIPN include less blood loss, shorter hospital stay, improved cosmesis, less postoperative pain, and fewer postoperative complications than open PN while maintaining early oncologic and functional outcomes. 19,20 However, the ability to manage intra-abdominal visceral and perinephric adipose tissue in obese patients during MIPN can pose a significant challenge for exposure, hilar dissection, tumor resection, and renorrhaphy.…”

Evaluation and Management of the Geriatric Urologic Oncology Patient

“…89 Surgeons at high-volume PN centers are attempting maximal renal preservation with early vascular unclamping, or even zero-ischemia, though these patients are highly selected and the approach may not be applicable to the elderly population. 90 Other nephron-sparing options include cryoablation, radiofrequency and thermal ablation, providing important alternatives for patients ineligible for surgery.…”