Perioperative Outcomes of Open, Laparoscopic, and Robotic Partial Nephrectomy: A Prospective Multicenter Observational Study (The RECORd 2 Project)

Bravi, Carlo Andrea; Larcher, Alessandro; Capitanio, Umberto; Mari, Andrea; Antonelli, Alessandro; Artibani, Walter; Barale, M.; Bertini, Roberto; Bove, Pierluigi; Brunocilla, Eugenio; Pozzo, L. Da; Maida, Fabrizio Di; Fiori, Cristian; Gontero, Paolo; Marzi, Vincenzo Li; Longo, Nicola; Mirone, Vincenzo; Montanari, Emanuele; Porpiglia, Francesco; Schiavina, Riccardo; Schips, Luigi; Simeone, Claudio; Siracusano, Salvatore; Terrone, Carlo; Trombetta, Carlo; Volpe, Alessandro; Montorsi, Francesco; Ficarra, Vincenzo; Carini, Marco

doi:10.1016/j.euf.2019.10.013

Cited by 69 publications

(55 citation statements)

References 31 publications

(47 reference statements)

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“…Considering the hilar clamping approach, in 47.9% of the TP and 51.6% of the RP surgeries, renal pedicle was not clamped. When hilar clamping was performed, the median (IQR) ischemia time was 19 (14-24) and 20 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) min for the two groups (p = 0.14). Simple enucleation was performed in 41.9% of the TP and 40.9% of the RP, respectively (p = 0.77).…”

Section: Surgical Featuresmentioning

confidence: 97%

Transperitoneal vs retroperitoneal minimally invasive partial nephrectomy: comparison of perioperative outcomes and functional follow-up in a large multi-institutional cohort (The RECORD 2 Project)

et al. 2020

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Background Aim of this study was to evaluate and compare perioperative outcomes of transperitoneal (TP) and retroperitoneal (TR) approaches in a multi-institutional cohort of minimally invasive partial nephrectomy (MI-PN). Material and methods All consecutive patients undergone MI-PN for clinical T1 renal tumors at 26 Italian centers (RECORd2 project) between 01/2013 and 12/2016 were evaluated, collecting the pre-, intra-, and postoperative data. The patients were then stratified according to the surgical approach, TP or RP. A 1:1 propensity score (PS) matching was performed to obtain homogeneous cohorts, considering the age, gender, baseline eGFR, surgical indication, clinical diameter, and PADUA score. Results 1669 patients treated with MI-PN were included in the study, 1256 and 413 undergoing TP and RP, respectively. After 1:1 PS matching according to the surgical access, 413 patients were selected from TP group to be compared with the 413 RP patients. Concerning intraoperative variables, no differences were found between the two groups in terms of surgical approach (lap/robot), extirpative technique (enucleation vs standard PN), hilar clamping, and ischemia time. Conversely, the TP group recorded a shorter median operative time in comparison with the RP group (115 vs 150 min), with a higher occurrence of intraoperative overall, 21 (5.0%) vs 9 (2.1%); p = 0.03, and surgical complications, 18 (4.3%) vs 7 (1.7%); p = 0.04. Concerning postoperative variables, the two groups resulted comparable in terms of complications, positive surgical margins and renal function, even if the RP group recorded a shorter median drainage duration and hospital length of stay (3 vs 2 for both variables), p < 0.0001. Conclusions The results of this study suggest that both TP and RP are feasible approaches when performing MI-PN, irrespectively from tumor location or surgical complexity. Notwithstanding longer operative times, RP seems to have a slighter intraoperative complication rate with earlier postoperative recovery when compared with TP.

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Section: Surgical Featuresmentioning

confidence: 97%

Transperitoneal vs retroperitoneal minimally invasive partial nephrectomy: comparison of perioperative outcomes and functional follow-up in a large multi-institutional cohort (The RECORD 2 Project)

et al. 2020

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“…All surgical procedures including open, laparoscopic, and robotic surgery were pooled in our analysis. A previous study showed that postoperative risk of AKI was halved for the patients treated by robotic or laparoscopic partial nephrectomy when compared with open surgery [49]. To further evaluate this association in our study cohort, we compared the incidence of AKI and the renal survival between the groups of surgical procedure.…”

Section: Discussionmentioning

confidence: 94%

Robust Association between Acute Kidney Injury after Radical Nephrectomy and Long-term Renal Function

Shin

Jang

et al. 2020

JCM

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The association between acute kidney injury (AKI) and long-term renal function after radical nephrectomy has not been evaluated fully. We reviewed 558 cases of radical nephrectomy. Postoperative AKI was defined by the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria. Values of estimated glomerular filtration rate (eGFR) were collected up to 36 months (median 35 months) after surgery. The primary outcome was new-onset chronic kidney disease (CKD) stage 3a or higher or all-cause mortality within three years after nephrectomy. The functional change ratio (FCR) of eGFR was defined as the ratio of the most recent GFR (24–36 months after surgery) to the new baseline during 3–12 months. A multivariable Cox proportional hazard regression analysis for new-onset CKD and a multivariable linear regression analysis for FCR were performed to evaluate the association between AKI and long-term renal outcomes. A correlation analysis was performed with the serum creatinine ratio and used to determine AKI and FCR. AKI occurred in 43.2% (n = 241/558) and our primary outcome developed in 40.5% (n = 226/558) of patients. The incidence of new-onset CKD was significantly higher in patients with AKI than those without at all follow-up time points after surgery. The Cox regression analysis showed a graded association between AKI and our primary outcome (AKI stage 1: Hazard ratio 1.71, 95% confidence interval 1.25–2.32; AKI stage 2 or 3: Hazard ratio 2.72, 95% confidence interval 1.78–4.10). The linear regression analysis for FCR showed that AKI was significantly associated with FCR (β = −0.168 ± 0.322, p = 0.011). There was a significant negative correlation between the serum creatinine ratio and FCR. In conclusion, our analysis demonstrated a robust and graded association between AKI after radical nephrectomy and long-term renal functional deterioration.

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“…In fact, the relationship between surgical techniques and complications remains controversial. Recently, a prospective multicenter study reported that minimally invasive surgery had lower rate of Clavien–Dindo ≥ 2 complications than that of open surgery . In contrast, Ng et al reported in a narrative review that laparoscopic partial nephrectomy share the equivalent incidence of complications as open partial nephrectomy .…”

Section: Discussionmentioning

confidence: 99%

The value of renal score in both determining surgical strategies and predicting complications for renal cell carcinoma: A systematic review and meta‐analysis

Shi

Zu²,

Shan

et al. 2020

Cancer Medicine

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Objectives: Radical nephrectomy (RN) was the standard treatment for renal cell carcinoma (RCC). However, recent studies have found that partial nephrectomy (PN) could achieve similar effects as radical nephrectomy, and has the advantages of less bleeding and shorter hospital stay. The choice of surgical strategies has become a concern of clinicians, which could be guided by renal score introduced by Kutikov et al Therefore, we conducted this meta-analysis to clarify the value of renal score of determining surgical strategies and predicting complications. Methods: The keywords "RENAL score," "renal nephrometry score," or "nephrometry score" were used to retrieve electronic databases for relevant literature up to Feb 2020, including PubMed, Web of Science, and the Cochrane library. Surgical strategies and complications are outcome measures. Risk ratio (RR) with 95% confidence intervals (CI) is applied to assess the effect size. Results: A total of 20 studies met the selection criteria for meta-analysis. There was significant difference in RN operation rate for each subgroup (low-moderate: RR = 3.50, 95% Cl = 2.60-4.71, P < .001; low-high: RR = 6.29, 95% Cl = 4.40-9.00, P < .001; moderate-high: RR = 1.80, 95% Cl = 1.39-2.32, P < .001).The overall incidence of complications from high renal score group was significantly higher than that in low renal score group (low-moderate: RR = 1.32, 95% Cl = 1.03-1.69, P = .026; low-high: RR = 2.45, 95% Cl = 1.48-4.07, P = .001; moderate-high: RR = 1.75, 95% Cl = 1.17-2.61, P = .007). Conclusions: This meta-analysis indicated that renal score is an efficient tool for determining surgical strategies and predicting complications in PN. More prospective research is essential to verify the predictive value of renal score. K E Y W O R D Scomplications, meta-analysis, Renal cell carcinoma, RENAL score, surgical strategiesThis is an open access article under the terms of the Creat ive Commo ns Attri bution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Perioperative Outcomes of Open, Laparoscopic, and Robotic Partial Nephrectomy: A Prospective Multicenter Observational Study (The RECORd 2 Project)

Cited by 69 publications

References 31 publications

Transperitoneal vs retroperitoneal minimally invasive partial nephrectomy: comparison of perioperative outcomes and functional follow-up in a large multi-institutional cohort (The RECORD 2 Project)

Transperitoneal vs retroperitoneal minimally invasive partial nephrectomy: comparison of perioperative outcomes and functional follow-up in a large multi-institutional cohort (The RECORD 2 Project)

Robust Association between Acute Kidney Injury after Radical Nephrectomy and Long-term Renal Function

The value of renal score in both determining surgical strategies and predicting complications for renal cell carcinoma: A systematic review and meta‐analysis

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