Robot‐assisted partial nephrectomy for large renal masses: a multi‐institutional series

Abstract

For T2a tumours RAPN is a feasible treatment option in a select patient population when performed by experienced surgeons in institutions equipped to manage postoperative complications. Although RAPN was associated with greater blood loss and longer operating and ischaemia time in T2a tumours, it was not associated with greater complication or positive surgical margin rates compared with T1 tumours. Renal function preservation rates were equivalent for up to 24 months postoperatively; however, 12-month recurrence-free survival was significantly lower in the T2a group. Extended follow-up is required to further evaluate long-term survival.

Comparison by Pentafecta Criteria of Transperitoneal and Retroperitoneal Robotic Partial Nephrectomy for Large Renal Tumors

“…20,21 A recent study of RPN reported low positive surgical margin rates, with 3.3% for cT1b renal tumors and 4.5% for cT2a renal tumors. 13 Our results with patients with ‡4 cm renal tumors also demonstrated lower positive margin rates with 1.7% for TRPN and 0% for RRPN. These results could be attributable to a single skillful surgeon performing surgeries in our study.…”

“…Retrospective studies reported patients with cT2a tumors demonstrated less differences in eGFR at 12 months than patients with with cT1 tumors after open, LPN and RPN. 13,29 Before our study, however, no studies have compared reduction in eGFR after one postoperative year between TRPN and RRPN in patients with ‡4 cm renal tumors. In our study, change in eGFR at 1 year postoperation was significantly more decreased at 1 year after RRPN than after TRPN for all patients ( p = 0.006) and patients with ‡4 cm renal tumors ( p = 0.008).In patients with ‡4 cm renal tumors, mean decrease in eGFR at 1 year postoperation was more than 10% for RRPN.…”

“…[10][11][12] The feasibility of RPN in patients with cT2a renal tumors is reported to be the same as for patients with cT1 renal tumors, including complications, positive margins, hospital stays, and decline of renal function. 13 Both transperitoneal and retroperitoneal approaches are used in minimally invasive partial nephrectomy. Approach is mainly determined by the location of the renal mass.…”

Laparoscopic vs robot‐assisted partial nephrectomy for renal tumours of >4 cm: a propensity score‐based analysis

“…However, these were based on renal masses in general (and actually mostly small ones of <4 cm). For the specific group of renal tumours of >4 cm, previous studies have reported the feasibility and safety of LPN [7][8][9] and RAPN [10][11][12][13][14]. The advantages of RAPN over LPN for renal tumours of >4 cm still needs to be validated and specified.…”

“…However, a laparoscopic approach may have more pronounced technical challenges than an open approach. RAPN can be considered as an evolution of LPN, with a number of published series proving its feasibility and safety for managing renal tumours of >4 cm [10][11][12][13][14].…”