A snapshot of nephron-sparing surgery in Italy: A prospective, multicenter report on clinical and perioperative outcomes (the RECORd 1 project)

Abstract

Introduction: Nephron-sparing surgery (NSS) has become the standard of care for the surgical management of small and clinically localized renal cell carcinoma (RCC). The conservative management of those RCCs is increasing over time. Aim of this study was to report a snapshot of the clinical, perioperative and oncological results after NSS for RCC in Italy. Results: Globally, 983 patients were evaluated. More recently, patients undergoing NSS were found to be significantly younger (p ¼ 0.05) than those surgically treated in the first study period, with a significantly higher rate of NSS with relative and imperative indication (p < 0.001). More recently, a higher percentage of procedures for cT1b or cT2 renal tumours was observed (p ¼ 0.02). Utilization rate of open partial nephrectomy (OPN) constantly decreased during years, laparoscopic partial nephrectomy (LPN) remained almost constant while robot-assisted partial nephrectomy (RAPN) increased. The rate of clampless NSS constantly increased over time. The use of at least one haemostatic agent has been significantly more adopted in the most recent surgical era (p < 0.001). Conclusions: The utilization rate of NSS in Italy is increasing, even in elective and more complex cases. RAPN has been progressively adopted, as well as the intraoperative utilization of haemostatic agents and the rate of clampless procedures.

Predictive factors of overall and major postoperative complications after partial nephrectomy: Results from a multicenter prospective study (The RECORd 1 project)

“…LPN was available in eleven centers and it was used since the beginning of the study, while RAPN was available in five high volume centers only in the last two years of data collection. 8 All surgeons were skilled in each of the three approaches performed: the choice among the approaches was primarily based on the availability of the technologies in the centres involved, but also on the surgeons' skills and experience. The different preoperative features, as comorbidity and the anatomical features of the tumors between the three approaches, might represent a possible bias in the analyses.…”

“…The RECORd project includes all patients who underwent conservative surgical treatment for radiologically diagnosed renal cell carcinoma (RCC) between January 2009 and December 2012 at 19 urological Italian Centers, upon the approval of the study protocol by the local ethical committee and patients' acceptance of the written informed consent. 8 An online central data server was generated. It contains anthropometric, preoperative, and imaging data, indications and comorbidities, intra and post-operative data, histopathological analysis.…”

Outcomes of Partial and Radical Nephrectomy in Octogenarians – A Multicenter International Study (Resurge)

“…Despite general trend is in favour of partial nephrectomy (PN) and minimally invasive approaches 2 , in many centers open radical nephrectomy (ORN) still represents the preferred surgical way in very elderly subjects 3 . Evidence supporting nephronsparing and minimally invasive approaches for these subjects remains sparse, and studies adopted liberal definitions of "elderly" (as over 65, 70 or 75 years 4,5 ) 6 .…”

External validation of the Simplified PADUA REnal (SPARE) nephrometry system in predicting surgical outcomes after partial nephrectomy

“…Most peri-operative outcomes in our study were similar to RECORd1 project, a 4-year prospective observational multicenter study. Major complication rate was 3.5%, positive surgical margin rate was 5.5%, and median ischemia time was 16 minutes in RECORd1 project [15,16]. The longer median ischemia time (24 minutes) in our study may be due to larger tumor size and low volume center (less than 50 PN performed per year).…”

“…In contrast to RECORd1 project, most patients in our cohort underwent standard PN by minimal invasive approach (76.8%). Since utilization rate of open partial nephrectomy constantly decreased in last decades [16]. Therefore, SPARE would be a more suitable nephrometry in the era of minimal invasive surgery.…”