Long-Term Oncological and Functional Outcomes After Robot-Assisted Partial Nephrectomy for Clinically Localized Renal Cell Carcinoma

Otaola-Arca, Hugo; Krebs, A; Bermúdez, Hugo; Lyng, Raúl; Orvieto, Marcelo A.; Bustamante, Alberto; Stein, Conrado; Labra, Andrés; Schultz, Marcela; Fernández, Mario

doi:10.1245/s10434-021-11133-4

Cited by 4 publications

(5 citation statements)

References 29 publications

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“…After fulfilling all the inclusion criteria, 13 studies were identified [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ], and another 17 studies were excluded mainly because follow-up was too short [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. All of the studies had an retrospective design except the ones from Furukawa et al [ 16 ] and Beauval et al [ 24 ].…”

Section: Resultsmentioning

confidence: 99%

Robot-Assisted Partial Nephrectomy Mid-Term Oncologic Outcomes: A Systematic Review

Vartolomei

Remzi

Fajković

et al. 2022

JCM

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Background: Robot-assisted partial nephrectomy (RAPN) is used more and more in present days as a therapy option for surgical treatment of cT1 renal masses. Current guidelines equally recommend open (OPN), laparoscopic (LPN), or robotic partial nephrectomy (PN). The aim of this review was to analyze the most representative RAPN series in terms of reported oncological outcomes. (2) Methods: A systematic search of Webofscience, PUBMED, Clinicaltrials.gov was performed on 1 August 2022. Studies were considered eligible if they: included patients with renal cell carcinoma (RCC) stage T1, were prospective, used randomized clinical trials (RCT) or retrospective studies, had patients undergo RAPN with a minimum follow-up of 48 months. (3) Results: Reported positive surgical margin rates were from 0 to 10.5%. Local recurrence occurred in up to 3.6% of patients. Distant metastases were reported in up to 6.4% of patients. 5-year cancer free survival (CFS) estimates rates ranged from 86.4% to 98.4%. 5-year cancer specific survival (CSS) estimates rates ranged from 90.1% to 100%, and 5-year overall survival (OS) estimates rated ranged from 82.6% to 97.9%. (4) Conclusions: Data coming from retrospective and prospective series shows very good oncologic outcomes after RAPN. Up to now, 10-year survival outcomes were not reported. Taken together, RAPN deliver similar oncologic performance to OPN and LPN.

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Section: Resultsmentioning

confidence: 99%

Robot-Assisted Partial Nephrectomy Mid-Term Oncologic Outcomes: A Systematic Review

Vartolomei

Remzi

Fajković

et al. 2022

JCM

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“…Actualmente existen pocos reportes sobre los resultados a largo plazo de la NPAR y no son concisos en cuanto a las MRP. De forma global, para la NPAR, independientemente del tamaño, se ha descrito una incidencia acumulada de recidiva local del 2.1-4.1% y de metástasis a distancia del 0.9-4.5%, una supervivencia global del 95-99% y una supervivencia específica de cáncer del 97-100%, con medianas de seguimiento entre 28 y 84 meses 19,[30][31][32] . En el presente estudio, con un diámetro tumoral máximo de 30 mm y una mediana de seguimiento de 53 meses, encontramos una incidencia acumulada de recidiva local o metástasis del 0%, una supervivencia específica de cáncer del 100% y una supervivencia global del 99%, lo que confirma los buenos resultados oncológicos de la NPAR en las MRP.…”

Section: Discussionunclassified

“…En Chile, diversos grupos han publicado su experiencia de nefrectomía parcial laparoscópica [13][14][15] , incluyendo el abordaje mano-asistido 16 . En el año 2014, Castillo O et al 17,18 presentaron su experiencia inicial con nefrectomía parcial asistida por robot (NPAR), y recientemente nosotros hemos publicado nuestra experiencia con 234 pacientes con tumores de hasta 10 cm 19 .…”

Section: Tratamiento Activounclassified

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Nefrectomía parcial robótica en tumores Ó� 3 cm. Complicaciones y resultados funcionales y oncológicos a largo plazo

Otaola-Arca¹,

Mejías²,

Krebs³

et al. 2023

RECHURO

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Objetivo: Evaluar las complicaciones perioperatorias y los resultados funcionales y oncológicos a largo plazo en pacientes sometidos a nefrectomía parcial asistida por robot (NPAR) por masas renales pequeñas. Método: Se evaluaron pacientes sometidos a NPAR (daVinci Si) por tumores ≤ 3 cm por tomografía computarizada o resonancia magnética entre enero de 2004 y diciembre de 2021. Se excluyeron los pacientes con afectación linfonodal o metástasis en el diagnóstico inicial o en un seguimiento < 6 meses. Se revisaron las características basales, las complicaciones intra-y postoperatorias, la función renal y los desenlaces oncológicos. Los datos se extrajeron de la base de datos institucional retro-y prospectiva aprobada por el Comité de Ética. Resultados: De los 330 pacientes operados, 195 calificaron para el análisis (se excluyeron 21 por tener un seguimiento < 6 meses, 37 por haberse realizado por vía abierta y 93 por vía laparoscópica). La mediana de seguimiento fue de 53 meses. El tamaño medio del tumor en las imágenes preoperatorias fue de 19.2 mm. La media de tiempo quirúrgico fue de 131 min. La media de sangrado fue de 189 mL. Hubo 5 (2.6%) complicaciones intra-y 7 (3.5%) postoperatorias, tres de ellas Clavien III. Las tasas de reingreso y reintervención fueron del 2.6% y el 1.5%, respectivamente. El análisis histológico reveló carcinoma de células claras en el 61% (n = 119). Entre los factores desfavorables se encontraron grados nucleares 3 o 4 en 34 (17.4%), invasión linfovascular en 12 (6.2%), márgenes quirúrgicos positivos en 10 (5.1%) y necrosis en 10 (5.1%). Ningún paciente presentó patrón sarcomatoide. Ningún paciente presentó recurrencia local ni a distancia, ni mortalidad específica de cáncer. Dos pacientes fallecieron por otras causas (mortalidad global del 1%). A los 12 meses, la creatinina sérica media fue de 1.01 mg/dL y solo 6 pacientes (3.1%) presentaron una tasa de filtración glomerular estimada < 60 mL/minute/1.73 m 2 de novo. Conclusiones: La NPAR en masas renales pequeñas es una técnica segura, con una excelente supervivencia a largo plazo y una buena preservación de la función renal en la mayoría de los pacientes.

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“…The robotic wrists provide extra degrees of freedom for easier distal ureter isolation and bladder closure, and its three dimensional magnified vision helps dissect lymph nodes around great vessels ( 6 ). During the last two decades, robotic-assisted surgeries have been increasingly utilized in renal cell carcinoma and prostate cancer ( 7 , 8 ). However, evidence focusing on RANU in UTUC are mostly limited to observational studies with mixed results.…”

Section: Introductionmentioning

confidence: 99%

Robot-assisted vs. laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma: a systematic review and meta-analysis based on comparative studies

Fang

et al. 2022

Front. Oncol.

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BackgroundRobot-assisted nephroureterectomy (RANU) and laparoscopic nephroureterectomy (LNU) are two minimally invasive surgical management for upper urinary tract urothelial carcinomas (UTUC). Though more high-tech, it remains largely unclear whether RANU provides additional benefits over LNU. We aimed to quantitatively compare the perioperative and oncologic outcomes between RANU and LNU.MethodsThe systematic review was performed based on a registered protocol (registration number CRD42022319086). We searched through PubMed, EMBASE and Cochrane databases, as well as conference proceedings and references of review articles (May 2022) for comparative studies reporting perioperative and oncologic outcomes independently in RANU and LNU groups. Selection of studies and data extraction were performed independently by two researchers. Risk of bias was assessed using the modified Newcastle-Ottawa Scale. Results of random-effects meta-analyses were presented as mean differences (MD) or Odds ratio (OR), as appropriate. Subgroup and univariate meta-regression analyses were performed to identify interstudy heterogeneities.ResultsThe review included 8470 patients undergoing RANU and 19872 patients undergoing LNU from 12 comparative original studies. RANU was associated with fewer overall complications (OR=0.71, 95%CI: 0.62 to 0.81), longer operative time (MD=27.70, 95%CI: 0.83 to 54.60) and shorter length of stay (MD=-0.53, 95%CI: -0.98 to -0.07) compared to LNU. In addition, patients receiving RANU were more likely to have lymph node dissected (OR=2.61, 95%CI: 1.86 to 3.65). Recurrence and survival outcomes did not differ between two surgical procedures. Sample size, types of LNU and world region were major sources of heterogeneity.ConclusionFor UTUC patients, RANU offers fewer complications and shorter hospitalization. However, RANU requires longer operative time and shares similar oncologic outcomes compared to LNU. Further randomized designed studies are warranted.Systematic Review Registrationwww.crd.york.ac.uk/prospero/, identifier CRD42022319086.

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Long-Term Oncological and Functional Outcomes After Robot-Assisted Partial Nephrectomy for Clinically Localized Renal Cell Carcinoma

Cited by 4 publications

References 29 publications

Robot-Assisted Partial Nephrectomy Mid-Term Oncologic Outcomes: A Systematic Review

Robot-Assisted Partial Nephrectomy Mid-Term Oncologic Outcomes: A Systematic Review

Nefrectomía parcial robótica en tumores Ó� 3 cm. Complicaciones y resultados funcionales y oncológicos a largo plazo

Robot-assisted vs. laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma: a systematic review and meta-analysis based on comparative studies

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