Three-year Oncologic and Renal Functional Outcomes After Robot-assisted Partial Nephrectomy

Khalifeh, Ali; Autorino, Riccardo; Eyraud, Rémi; Samarasekera, Dinesh; Laydner, Humberto; Panumatrassamee, Kamol; Stein, Robert J.; Kaouk, Jihad

doi:10.1016/j.eururo.2013.03.052

Cited by 91 publications

(63 citation statements)

References 25 publications

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“…There was no positive surgical margin of our first 77 consecutive RAPN patients in different clamping techniques. The previous studies reported that there was 0–7% of positive surgical margin after PN [2, 9, 13, 14]. According to these findings, it may be an interesting strategy to perform SAC or OCT to minimize WIT by obtaining a comparatively bloodless surgical view as well as achieving oncological outcome.…”

Section: Discussionmentioning

confidence: 95%

“…Despite increased cost of purchase and maintenance of operating machines and instruments, RAPN has been performed globally as it facilitates dissection and intracorporeal suturing [22]. Khalifeh et al [2] reported oncologic and renal functional outcomes after RAPN. Overall survival, cancer-free survival, and cancer-specific survival at 5 years were 90.2, 98.9, and 99.0%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Partial nephrectomy (PN) has become the standard surgical treatment for small renal masses due to providing comparable oncological outcomes, better preservation of renal function, and overall survival [1-3]. Robot-assisted PN (RAPN) has increasingly been performed as overcoming technical challenges of laparoscopic PN [2, 4]. Given that bloodless operative field facilitates tumor resection and renal reconstruction, PN is traditionally performed with main renal arterial clamping (MAC).…”

Section: Introductionmentioning

confidence: 99%

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The Impact of Arterial Clamping Technique in Robot-Assisted Partial Nephrectomy on Renal Function and Surgical Outcomes: Six-Year Experience at Siriraj Hospital, Thailand

Taweemonkongsap¹,

Suk-Ouichai²,

Chotikawanich³

et al. 2018

Urol Int

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Introduction: Robot-assisted partial nephrectomy (RAPN) with different arterial clamping techniques has increasingly been performed to avoid ischemic injury to nephron. However, postoperative renal function remains controversial. We determine the impact of each renal arterial clamping on surgical and renal outcomes after RAPN. Materials and Methods: Patients who underwent RAPN at Siriraj Hospital from 2010 to 2016 were retrospectively reviewed and stratified into 3 cohorts: main-clamp (MAC), selective-clamp, and off-clamp. Results: Main, selective, and off-clamping were performed in 27, 38, and 12, respectively. Median tumor size and Radius, Exophytic or endophytic, Nearness to collecting system or sinus, Anterior or posterior, and Location relative to polar lines (RENAL) score were 3 cm and 7, respectively. Longer operative time was observed in MAC (p = 0.002) although estimated blood loss, transfusion rate, and complication were comparable. Warm ischemia time was not different between cohorts. However, number of patients with prolonged ischemia time in MAC were greater (p ≤ 0.01). All margins were negative. Median postoperative and latest glomerular filtration rate reduction were 3.8 and 5.3 mL/min/1.73 m², respectively without significant difference between cohorts. On multivariable analysis, hypertension independently associated with reduced renal function preserved (p = 0.03). Median follow-up was 18 months. Conclusions: Our study is the first to report surgical and renal functional outcomes after RAPN in Southeast-Asian population. Based on our experience, clamping techniques does not impact on renal functions and complication rate was low even in small-volume center.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Impact of Arterial Clamping Technique in Robot-Assisted Partial Nephrectomy on Renal Function and Surgical Outcomes: Six-Year Experience at Siriraj Hospital, Thailand

Taweemonkongsap¹,

Suk-Ouichai²,

Chotikawanich³

et al. 2018

Urol Int

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“…48 In a study of 134 patients treated with RPN and followed for a minimum of 2 years, Khalifeh et al reported actuarial 5-year overall survival and cancer-specific survival rates of 90% and 99%, respectively. 49 Gupta et al similarly reported no local or metastatic recurrences following RPN at a median follow-up of 22 months. 78 Despite these early promising data for RPN, some studies have also shown a higher, albeit statistically insignificant, occurrence of positive surgical margins 79 Early studies had demonstrated an insignificant oncologic effect of PSM with respect to local or metastatic recurrence, 80,81 but emerging data conflict with these earlier findings.…”

Section: Oncologic Outcomesmentioning

confidence: 92%

“…48 Similarly, in a study of RPN with intermediate-term follow-up, only an 8% mean decrease in postoperative eGFR was observed at a mean follow-up of 3 years. 49 Longer-term comparisons of functional outcomes for RPN with other surgical approaches are currently lacking. …”

Section: Outcomes Of Lpn Functional Outcomesmentioning

confidence: 99%

Laparoscopic partial nephrectomy: state of the art review

Faiena¹,

Han²,

Olweny³

2014

OAS

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Introduction:The surgical management of small renal masses (,4 cm) has greatly evolved over the last few decades, with the paradigm shifting from radical to partial nephrectomy. Laparoscopic partial nephrectomy (LPN) is increasingly utilized, and has achieved similar outcomes to open partial nephrectomy with decreased patient morbidity in experienced hands. The aim of this review was to examine the current status and future direction of LPN. Materials and methods:We performed a nonsystematic review of the literature using a free-text protocol in the PubMed database, using the terms "laparoscopic partial nephrectomy", "robotassisted partial nephrectomy", "robotic partial nephrectomy", and "laparoscopic partial nephrectomy oncologic and functional outcomes". Only English language articles were selected. Evidence synthesis: Our search results yielded 1,136. Three authors reviewed the results, and articles with information on patient and tumor selection, surgical techniques, and oncologic and functional outcomes were included. With regard to outcomes, only series with the largest cohorts and longest follow-up were selected. Conclusion: LPN has evolved rapidly over the past 2 decades, and advances in technique as well as innovations in surgical technologies have facilitated its increased adoption in urologic practice. However, limitations remain, such as inadequacy of techniques to achieve cold ischemia laparoscopically, high technical demands of intracorporeal suturing, and limited ability to assess surgical anatomy beyond the field of view. These comprise goals of research aimed at improving future surgical precision and outcomes, while further decreasing the invasiveness of LPN.

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Robot‐assisted versus laparoscopic partial nephrectomy for anatomically complex T1b renal tumors with a RENAL nephrometry score ≥7: A propensity score‐based analysis

Deng

Liu

et al. 2019

Cancer Medicine

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Objectives:To present the perioperative, functional, and oncological outcomes of robot-assisted partial nephrectomy (RPN) compared with laparoscopic partial nephrectomy (LPN) for anatomically complex T1b renal tumors with RENAL nephrometry scores ≥7. Patients and methods: One hundred and seventy patients, during the study period, were retrospectively reviewed in our analysis according to inclusion criteria.Propensity score matching (PSM) (1:1) method was applied to impose restrictions on the potential baseline confounders. The comparisons of perioperative and functional outcomes between the RPN and LPN groups were conducted and analyzed after PSM, Kaplan-Meier analyses were performed to assess the differences about oncological outcomes between the two groups before and after PSM. Results: One hundred and nine and 61 T1b renal tumors with RENAL scores ≥7 were identified in the LPN and RPN groups, respectively. All significant differences in baseline characteristics disappeared after PSM. Except for 3 patients missing an appropriate pair, all the patients in the RPN group were successfully matched to 58 patients in the LPN group in a 1:1 ratio. Within the matched cohort, the RPN group was related to a significantly shorter mean operating time (OT) (P = .040), shorter mean warm ischemia time (WIT) (P = .023), and shorter median postoperative hospital stay (P = .023). The possibilities of surgical conversion, postoperative complication, and positive surgical margin were similar in the LPN and RPN groups.And there was also no significant difference in the pathological, renal functional, and oncological outcomes between the two series. Conclusions: For patients with anatomically complex T1b renal tumors with a RENAL nephrometry score ≥7, RPN had an advantage over LPN in reducing OT, WIT, and postoperative hospital stay length without increasing the risk of | 587 DENG Et al.

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Three-year Oncologic and Renal Functional Outcomes After Robot-assisted Partial Nephrectomy

Cited by 91 publications

References 25 publications

The Impact of Arterial Clamping Technique in Robot-Assisted Partial Nephrectomy on Renal Function and Surgical Outcomes: Six-Year Experience at Siriraj Hospital, Thailand

The Impact of Arterial Clamping Technique in Robot-Assisted Partial Nephrectomy on Renal Function and Surgical Outcomes: Six-Year Experience at Siriraj Hospital, Thailand

Laparoscopic partial nephrectomy: state of the art review

Robot‐assisted versus laparoscopic partial nephrectomy for anatomically complex T1b renal tumors with a RENAL nephrometry score ≥7: A propensity score‐based analysis

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