Trifecta outcomes of modified robot-assisted simple enucleation and standard robot-assisted partial nephrectomy for treating clinical T1b renal cell carcinoma

Abstract

Background: To compare perioperative outcomes and Trifecta achievement of modified robot-assisted simple enucleation (MRASE) with robot-assisted partial nephrectomy (RAPN) for treating clinical T1b renal tumors. Methods: We analyzed 203 patients who underwent MRASE or RAPN for clinical T1b renal tumors at our institution from September 2014 to June 2018. The two groups were compared regarding perioperative outcome variables. Trifecta was defined as no perioperative complications, negative surgical margin, and ischemia time ≤25 minutes. Results: In all, 139 patients underwent MRASE and 64 underwent RAPN respectively. Patients in the MRASE group had shorter operative time (197.7 vs. 215.6 min, P=0.039) and warm ischemic time (21.2 vs.24.1 min, P=0.004) in comparison to the RAPN group. The groups were comparable in estimated blood loss (230.5 vs. 269.8 mL, P=0.259). Tumor bed suturing was performed with a significantly lower frequency in the MRASE group than in the RAPN group (11.5% vs. 90.6%, P<0.01). The incidence of perioperative complications was similar. The rate of positive surgical margins was similar in both groups (2.2% vs. 6.3%, P=0.284). Trifecta was achieved in 61.2% and 42.2% of MRASE and RAPN patients (P=0.012). On multivariable analysis, the type of procedure, RENAL score, estimated blood loss, and operative time were positive factors for the achievement of Trifecta.Conclusions: In this series MRASE was superior to RAPN with regard to the achievement of Trifecta in treating T1b renal tumors. Besides, MRASE had better outcomes for shorter operative time, shorter warm ischemic time, and less need for tumor bed suturing as compared with RAPN.

Tumor enucleation for the treatment of T1 renal tumors: A systematic review and meta-analysis

“…Fifteen of the 17 studies were published in English; the other 2 were published in Spanish [ 40 ] and Russian [ 41 ], respectively. The countries of origins of the included studies were China [ 42 43 44 45 46 ], Japan [ 47 48 ], Italy [ 49 50 ], Spain [ 40 ], Romania [ 51 52 ], Russia [ 41 ], and the United States [ 53 54 55 56 ]. We attempted to contact the corresponding authors of the included studies to obtain additional information on the study methodology and results and received replies for two studies [ 53 55 ].…”

“…The mean (or median) duration of warm ischemia ranged from 4 to 27 minutes. The residual renal function measured by GFR was reported perioperatively [ 43 48 52 55 ], within 3 months of surgery [ 43 47 ], and at 3 months after surgery [ 43 45 48 51 ]. Two NRSs reported cancer-specific mortality (follow-up: median 18 to 37 months), but no study reported overall mortality [ 42 43 ].…”

“…Two NRSs reported cancer-specific mortality (follow-up: median 18 to 37 months), but no study reported overall mortality [ 42 43 ]. Major adverse events were reported in 10 NRSs [ 42 43 44 45 47 48 49 50 52 55 ]. Local recurrence was reported in 6 studies including 1 RCT [ 42 43 44 45 46 52 ].…”

“…Major adverse events were reported in 10 NRSs [ 42 43 44 45 47 48 49 50 52 55 ]. Local recurrence was reported in 6 studies including 1 RCT [ 42 43 44 45 46 52 ]. Distant metastasis was reported in three studies [ 42 43 52 ].…”

“…Distant metastasis was reported in three studies [ 42 43 52 ]. A positive surgical margin was reported in 15 studies including 1 RCT [ 40 41 42 43 44 45 46 47 48 49 50 52 53 54 55 ]. Overall adverse events were reported in 13 NRSs [ 40 41 42 43 44 45 47 48 49 50 52 55 56 ].…”