Pushing the Boundaries of Robotic-assisted Partial Nephrectomy: Oncological and Functional Outcomes of Localized Stage pT1a to pT3a Renal Tumors
CUA Online Library. Bladou F. 06/24/13; 31266; MP-03.09
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Abstract
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Background:
Robot-assisted partial nephrectomy (RALPN) has been increasingly adopted in most countries although open procedure continues to be the reference nephron-sparing technique. We aimed to describe our initial surgical outcomes of RALPN for renal tumors in our single institution robotic program.
Methods:
Between January 2011 and February 2013, 65 consecutive patients underwent a RALPN by two surgeons. Preoperative characteristics including the RENAL nephrometry score, perioperative parameters and postoperative course including renal function were assessed from a retrospective database. Mean follow-up was 12 months.
Results:
Mean age was 60.2 years. Mean tumor size was 3.9 cm. The RENAL nephrometry score classified tumors as moderately and highly complex tumors in 51% and 18.5% of cases, respectively. Median warm ischemia time (WIT) was 21 minutes. Factors associated with WIT were RENAL nephrometry score, tumor size, complications’ rate and surgeon’s experience. No conversion or grade 4-5 complication was reported. Mean hospital stay was 3 days. The overall complication rate was 24.6% (re-admission rate 7.7%), and decreased to 12% after 20 cases. After these initial 20 cases, a trifecta rate (no margins, preserved renal function, no complications) of 64.3% was achieved in moderately and highly complex tumors. Mean change in eGFR was 6.7 ml/min without severe postoperative renal failure.
Interpretation:
RALPN is a safe and feasible procedure with low specific morbidity even in moderately or highly complex renal masses. The warm ischemia time depends on tumor characteristics, mainly determined by the RENAL nephrometry score and may be improved by surgeon’s experience. Longer follow-up is needed to assess the oncologic mid-term safety of the procedure and a larger cohort may lead to a more accurate analysis of the learning curve.
Robot-assisted partial nephrectomy (RALPN) has been increasingly adopted in most countries although open procedure continues to be the reference nephron-sparing technique. We aimed to describe our initial surgical outcomes of RALPN for renal tumors in our single institution robotic program.
Methods:
Between January 2011 and February 2013, 65 consecutive patients underwent a RALPN by two surgeons. Preoperative characteristics including the RENAL nephrometry score, perioperative parameters and postoperative course including renal function were assessed from a retrospective database. Mean follow-up was 12 months.
Results:
Mean age was 60.2 years. Mean tumor size was 3.9 cm. The RENAL nephrometry score classified tumors as moderately and highly complex tumors in 51% and 18.5% of cases, respectively. Median warm ischemia time (WIT) was 21 minutes. Factors associated with WIT were RENAL nephrometry score, tumor size, complications’ rate and surgeon’s experience. No conversion or grade 4-5 complication was reported. Mean hospital stay was 3 days. The overall complication rate was 24.6% (re-admission rate 7.7%), and decreased to 12% after 20 cases. After these initial 20 cases, a trifecta rate (no margins, preserved renal function, no complications) of 64.3% was achieved in moderately and highly complex tumors. Mean change in eGFR was 6.7 ml/min without severe postoperative renal failure.
Interpretation:
RALPN is a safe and feasible procedure with low specific morbidity even in moderately or highly complex renal masses. The warm ischemia time depends on tumor characteristics, mainly determined by the RENAL nephrometry score and may be improved by surgeon’s experience. Longer follow-up is needed to assess the oncologic mid-term safety of the procedure and a larger cohort may lead to a more accurate analysis of the learning curve.
Background:
Robot-assisted partial nephrectomy (RALPN) has been increasingly adopted in most countries although open procedure continues to be the reference nephron-sparing technique. We aimed to describe our initial surgical outcomes of RALPN for renal tumors in our single institution robotic program.
Methods:
Between January 2011 and February 2013, 65 consecutive patients underwent a RALPN by two surgeons. Preoperative characteristics including the RENAL nephrometry score, perioperative parameters and postoperative course including renal function were assessed from a retrospective database. Mean follow-up was 12 months.
Results:
Mean age was 60.2 years. Mean tumor size was 3.9 cm. The RENAL nephrometry score classified tumors as moderately and highly complex tumors in 51% and 18.5% of cases, respectively. Median warm ischemia time (WIT) was 21 minutes. Factors associated with WIT were RENAL nephrometry score, tumor size, complications’ rate and surgeon’s experience. No conversion or grade 4-5 complication was reported. Mean hospital stay was 3 days. The overall complication rate was 24.6% (re-admission rate 7.7%), and decreased to 12% after 20 cases. After these initial 20 cases, a trifecta rate (no margins, preserved renal function, no complications) of 64.3% was achieved in moderately and highly complex tumors. Mean change in eGFR was 6.7 ml/min without severe postoperative renal failure.
Interpretation:
RALPN is a safe and feasible procedure with low specific morbidity even in moderately or highly complex renal masses. The warm ischemia time depends on tumor characteristics, mainly determined by the RENAL nephrometry score and may be improved by surgeon’s experience. Longer follow-up is needed to assess the oncologic mid-term safety of the procedure and a larger cohort may lead to a more accurate analysis of the learning curve.
Robot-assisted partial nephrectomy (RALPN) has been increasingly adopted in most countries although open procedure continues to be the reference nephron-sparing technique. We aimed to describe our initial surgical outcomes of RALPN for renal tumors in our single institution robotic program.
Methods:
Between January 2011 and February 2013, 65 consecutive patients underwent a RALPN by two surgeons. Preoperative characteristics including the RENAL nephrometry score, perioperative parameters and postoperative course including renal function were assessed from a retrospective database. Mean follow-up was 12 months.
Results:
Mean age was 60.2 years. Mean tumor size was 3.9 cm. The RENAL nephrometry score classified tumors as moderately and highly complex tumors in 51% and 18.5% of cases, respectively. Median warm ischemia time (WIT) was 21 minutes. Factors associated with WIT were RENAL nephrometry score, tumor size, complications’ rate and surgeon’s experience. No conversion or grade 4-5 complication was reported. Mean hospital stay was 3 days. The overall complication rate was 24.6% (re-admission rate 7.7%), and decreased to 12% after 20 cases. After these initial 20 cases, a trifecta rate (no margins, preserved renal function, no complications) of 64.3% was achieved in moderately and highly complex tumors. Mean change in eGFR was 6.7 ml/min without severe postoperative renal failure.
Interpretation:
RALPN is a safe and feasible procedure with low specific morbidity even in moderately or highly complex renal masses. The warm ischemia time depends on tumor characteristics, mainly determined by the RENAL nephrometry score and may be improved by surgeon’s experience. Longer follow-up is needed to assess the oncologic mid-term safety of the procedure and a larger cohort may lead to a more accurate analysis of the learning curve.
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