MP41-20 RACE EFFECTS ON PATHOLOGICAL AND FUNCTIONAL OUTCOMES AFTER ROBOTIC PARTIAL NEPHRECTOMY

602 Background: To compare and analyze surgical, oncological and functional outcomes of transperitoneal (TRPN) and retroperitoneal robotic partial nephrectomy (RRPN). Methods: Out of 566 consecutive patients who underwent RAPN by a single surgeon from December 2008 to July 2017, this study included 523 patients (TRPN 310, RRPN 213) who evaluated preoperative and 1-year postoperative estimated glomerular filtration rate (eGFR). Our primary endpoint was to compare the perioperative and postoperative outcomes of both approaches by the measure of Pentafecta (negative surgical margin, no 30-day complication, warm ischemic time (WIT) ≤25 minutes, return of estimated glomerular filtration rate (eGFR) to > 90% from baseline and no upstaging of chronic kidney disease). Secondary endpoint was to find the factors associated with Pentafecta by multivariate regression analysis. Results: No significant difference was found in terms of age, BMI, laterality, history of hypertension or diabetes, ASA grade, tumor size and RENAL nephrometry score. These outcomes were lower in the RRPN group: operative time [median (IQR) 244 (202-295) vs. 273 (230-314); p < 0.001], WIT [median (IQR) 19 (15-25) vs. 21 (16-27); p < 0.008] and estimated blood loss (EBL) [median (IQR) 100 (60-200) vs. 150 (100-200); p < 0.003]. Hospital stay, baseline eGFR, 1-year postoperative eGFR, the rate of Pentafecta achievement, recurrence and complications were not different. The rate of WIT ≤ 25 minutes was solely significantly different (TRPN 69.7% vs. RRPN 77.9%, p = 0.045) in the Pentafecta criteria. Multivariate analysis revealed tumor size [OR (95% CI) 0.641 (0.536-0.767), p < 0.001) and hospital stays (OR 0.639, p < 0.001) as predictive for lack of Pentafecta. Conclusions: RRPN demonstrated less operative time, WIT and EBL than TPRN. Pentafecta achievements were equivalent in both approaches. Tumor size and hospital stays were found as predictive factors of Pentafecta.

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A Single Surgeon’s Experience with Open, Laparoscopic, and Robotic Partial Nephrectomy

International Scholarly Research Notices ◽

10.1155/2014/430914 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Zachary Klaassen ◽

Robert M. Kohut ◽

Dhruti Patel ◽

Martha K. Terris ◽

Rabii Madi

Keyword(s):

Glomerular Filtration Rate ◽

Partial Nephrectomy ◽

Functional Outcomes ◽

Filtration Rate ◽

Patient Characteristics ◽

Laparoscopic Partial Nephrectomy ◽

Perioperative Outcomes ◽

Robotic Partial Nephrectomy ◽

Open Partial Nephrectomy ◽

Preoperative Patient

Objective. To report the perioperative outcomes of patients treated with partial nephrectomy by a single surgeon using three surgical modalities—open, laparoscopic, and robotic. Methods. Between August 2006 and February 2012, 106 consecutive patients underwent open partial nephrectomy (OPN) (n=23), laparoscopic partial nephrectomy (LPN) (n=48), and robotic partial nephrectomy (RPN) (n=35) by a single surgeon. Clinical variables, operative parameters, and renal functional outcomes were analyzed. Results. Preoperative patient characteristics were similar except for baseline glomerular filtration rate (GFR), which was highest in the RPN group (P=0.004). Surgery time was longest in the RPN group (244 minutes) and shortest in the OPN group (163 minutes, P<0.0001). Patients who had OPN had the highest incidence of 30-day complications (30%), while the RPN approach had the lowest (14%, P=0.008). Conclusions. When performed by a single surgeon, robotic partial nephrectomy appears to be associated with fewer complications than both open and laparoscopic partial nephrectomy. Kidney function was not affected by surgical approach.

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