Robot-Assisted Partial Nephrectomy for Totally Endophytic Renal Tumors: Step by Step Standardized Surgical Technique and Long-Term Outcomes with a Median 59-Month Follow-Up

Raheem, Ali Abdel; Chang, Kihun; Alenzi, Mohammed Jayed; Lum, Trenton G.; Ham, Won Sik; Han, Woong Kyu; Chung, Byung Ha; Choi, Young Deuk; Rha, Koon Ho

doi:10.1089/lap.2018.0124

Cited by 9 publications

(9 citation statements)

References 33 publications

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“…We reported a significantly shorter operative time than on‐clamp series (median 82 min), as the time‐consuming hilum isolation surgical step is not performed. Moreover, with a negligible transfusion rate (3.6%), a 10.7% rate of overall complications and acceptable EBL (median 350 mL), our perioperative data are in line with the existing data reported in on‐clamp series 11–14 …”

Section: Discussionsupporting

confidence: 89%

“…Regarding survival outcomes, our series showed 2‐year LRFS, CSS, and OS rates of 100%, 100%, and 98.2%, respectively, confirming the excellent oncological results of other series with a follow‐up longer than the present study (2‐year) 13 . Renal function preservation undoubtedly remains the crucial aspect of NSS; according to the existing literature, the main determinants of functional outcomes consist of the quantity of parenchyma preserved, the ischaemia time and the baseline eGFR.…”

Section: Discussionsupporting

confidence: 88%

“…Since then, there have been a few other published papers focused on the same topic, 12–14 all confirming the feasibility of RPN in endophytic masses. In addition, in a more recent multicenter study, Carbonara et al 21 .…”

Section: Discussionmentioning

confidence: 85%

“…In this context, there is only little evidence concerning outcomes of robotic treatment of these technically complex situations, all of which derives from a few on‐clamp series, 11–14 while evidence coming from off‐clamp series is lacking. We recently described a novel technique for marking TERTs preoperatively with transarterial superselective intrarenal mass delivery of an ICG‐lipiodol mixture, in order to enhance surgical margin control during purely off‐clamp RPN, with the use of NIRI, and reported our preliminary results 15 …”

Section: Introductionmentioning

confidence: 99%

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Expanding the limits of nephron‐sparing surgery: Surgical technique and mid‐term outcomes of purely off‐clamp robotic partial nephrectomy for totally endophytic renal tumors

et al. 2022

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Objectives: To report surgical technique, perioperative, oncological, and mid-term functional outcomes in a single-center purely off-clamp robotic partial nephrectomy series for totally endophytic masses. Methods: A retrospective analysis of a prospectively collected, institutional review board-approved renal cancer database was carried out to include patients with a totally endophytic renal tumor treated with off-clamp robotic partial nephrectomy between January 2013 and December 2020 at our center. Our database was queried to identify cases that had been assigned 3 points for the "E" domain of the R.E.N.A.L. nephrometry score and 3 points for the "exophytic rate" domain of the PADUA (Preoperative Aspects and Dimensions Used for an Anatomical) nephrometry score. Preoperative indocyanine green renal mass marking was performed in 33 patients, in whom the tumor was vascularized by a specific feeding artery. Surgical steps, perioperative, oncological and functional data were reported. Results: Fifty-six consecutive patients with totally endophytic renal masses were treated. The median tumor diameter was 3 cm, and median PADUA and R.E.N.A.L. scores were both 10. The median operative time was 82 min. Low-grade Clavien complications occurred in two patients (3.6%) and high-grade Clavien complications were observed in four patients (7.1%). Positive surgical margins were detected in one patient; 2-year recurrence-free, cancer-specific, and overall survival rates were 100%, 100%, and 98.2%, respectively. At a median follow-up of 24 months, new onset of chronic kidney disease stage 3b occurred in one patient. At last follow-up, the median estimated glomerular filtration rate was 77 mL/min, with a median estimated glomerular filtration rate percent decrease of 5.5%. Trifecta was achieved in 91% of patients. Conclusions: Purely off-clamp robotic partial nephrectomy is a feasible and safe surgical approach, even in totally endophytic renal tumors, providing a favorable perioperative complications rate, excellent oncological outcomes, and negligible impact on renal function at mid-term follow-up. Indocyanine green preoperative marking of endophytic renal tumors represents a useful tool for rapid intraoperative identification of the mass, real-time control of resection margins, and a more precise dissection.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

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Expanding the limits of nephron‐sparing surgery: Surgical technique and mid‐term outcomes of purely off‐clamp robotic partial nephrectomy for totally endophytic renal tumors

et al. 2022

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“…Another developing field in the group of minimally invasive techniques is robotic surgery: some studies [ 56 , 57 ] analysed the feasibility, safety and effectiveness of robotic CME, which could be considered as another possible technique to assist CME and having potential for improving the outcomes and quality of life of patients, such as many studies also suggest for laparoscopic procedures as compared to traditional open surgery [ 58 , 59 ]. However, data are still missing, and the number of studies needs to be increased in order to evaluate this alternative minimally invasive approach.…”

Section: Discussionmentioning

confidence: 99%

A global systematic review and meta-analysis on laparoscopic vs open right hemicolectomy with complete mesocolic excision

Anania

Arezzo

Davies

et al. 2021

Int J Colorectal Dis

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Purpose The aim of this study was to compare the outcomes of right hemicolectomy with CME performed with laparoscopic and open surgery. Methods PubMed, Scopus, Web of Science, China National Knowledge Infrastructure, Wanfang Data, Google Scholar and the ClinicalTrials.gov register were searched. Primary outcome was the overall number of harvested lymph nodes. Secondary outcomes were short and long-term course variables. A meta-analysis was performed to calculate risk ratios. Results Twenty-one studies were identified with 5038 patients enrolled. The difference in number of harvested lymph nodes was not statistically significant (MD 0.68, − 0.41–1.76, P = 0.22). The only RCT shows a significant advantage in favour of laparoscopy (MD 3.30, 95% CI − 0.20–6.40, P = 0.04). The analysis of CCTs showed an advantage in favour of the laparoscopic group, but the result was not statically significantly (MD − 0.55, 95% CI − 0.57–1.67, P = 0.33). The overall incidence of local recurrence was not different between the groups, while systemic recurrence at 5 years was lower in laparoscopic group. Laparoscopy showed better short-term outcomes including overall complications, lower estimated blood loss, lower wound infections and shorter hospital stay, despite a longer operative time. The rate of anastomotic and chyle leak was similar in the two groups. Conclusions Despite the several limitations of this study, we found that the median number of lymph node harvested in the laparoscopic group is not different compared to open surgery. Laparoscopy was associated with a lower incidence of systemic recurrence.

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A systematic review of robot-assisted partial nephrectomy outcomes for advanced indications: Large tumors (cT2-T3), solitary kidney, completely endophytic, hilar, recurrent, and multiple renal tumors

Pandolfo,

Cerrato,

et al. 2023

Asian Journal of Urology

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Robot-Assisted Partial Nephrectomy for Totally Endophytic Renal Tumors: Step by Step Standardized Surgical Technique and Long-Term Outcomes with a Median 59-Month Follow-Up

Cited by 9 publications

References 33 publications

Expanding the limits of nephron‐sparing surgery: Surgical technique and mid‐term outcomes of purely off‐clamp robotic partial nephrectomy for totally endophytic renal tumors

Expanding the limits of nephron‐sparing surgery: Surgical technique and mid‐term outcomes of purely off‐clamp robotic partial nephrectomy for totally endophytic renal tumors

A global systematic review and meta-analysis on laparoscopic vs open right hemicolectomy with complete mesocolic excision

A systematic review of robot-assisted partial nephrectomy outcomes for advanced indications: Large tumors (cT2-T3), solitary kidney, completely endophytic, hilar, recurrent, and multiple renal tumors

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