920 Superior renal function after selective clamping robotic partial nephrectomy – a matched pair study for baseline eGFR with short- and intermediate-term follow-up

Objective: To evaluate the effect of warm ischemic time (WIT) on future renal function (RF) after robotic partial nephrectomy (RPN) and secondarily, also to find out predictors of future RF after RPN. Method and materials: All patients who underwent RPN with normal pre-operative RF and normal contralateral kidney were included in the study except for those in whom one-year follow up was not completed. Patients were divided in four groups based on WIT (zero, <20minutes, 20 minutes to 30 minutes and >30 minutes). Comparison of demographic and perioperative parameters including follow-up up to one year were done. Univariable and multivariable analysis were done to detect significant correlation of RF with those parameters. Results: Total 198 RPN patients were included in the study. The four groups had comparable demographic data (age, gender, comorbidity, smoking, body mass index, pre-operative RF). Progressively increased WIT was significantly associated with increased tumour size (p=0.022), RENAL nephrometry score (p=0.003), operative time (p=0.004) and blood loss (p=0.046). Post-operatively, RF on first post-operative day (p=0.627), at one month (p=0.581) and at one year (p=0.378) had no significant difference between the four groups. Nine (4.5%) patients progressed to chronic renal disease. Pre-operative RF and perioperative complications only had significant correlation with one-year RF. Conclusion: Tumour size and RENAL nephrometry score significantly influenced WIT. Pre-operative RF and peri-operative complications were the only significant predictors of future RF and not the WIT.

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MP75-04 OFF-CLAMP TECHNIQUE OFFERS IMPROVED RENAL FUNCTION OUTCOMES AFTER ROBOTIC PARTIAL NEPHRECTOMY IN LOW AND INTERMEDIATE COMPLEXITY TUMORS

The Journal of Urology ◽

10.1016/j.juro.2016.02.1722 ◽

2016 ◽

Vol 195 (4S) ◽

Cited By ~ 1

Author(s):

Daniel C. Rosen ◽

David J. Paulucci ◽

Ronney Abaza ◽

Daniel D. Eun ◽

Ashok K. Hemal ◽

...

Keyword(s):

Renal Function ◽

Partial Nephrectomy ◽

Robotic Partial Nephrectomy ◽

Clamp Technique ◽

Intermediate Complexity

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Is off‐clamp robotic partial nephrectomy beneficial for renal function? data from the clock trial

BJU International ◽

10.1111/bju.15503 ◽

2021 ◽

Author(s):

Alessandro Antonelli ◽

Luca Cindolo ◽

Marco Sandri ◽

Alessandro Veccia ◽

Filippo Annino ◽

...

Keyword(s):

Renal Function ◽

Partial Nephrectomy ◽

Robotic Partial Nephrectomy ◽

Function Data

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Da Vinci-Assisted Robotic Partial Nephrectomy: Technique and Results at a Mean of 15 Months of Follow-Up

European Urology ◽

10.1016/j.eururo.2006.06.002 ◽

2007 ◽

Vol 51 (1) ◽

pp. 186-192 ◽

Cited By ~ 154

Author(s):

Sanjeev Kaul ◽

Rajesh Laungani ◽

Richard Sarle ◽

Hans Stricker ◽

James Peabody ◽

...

Keyword(s):

Partial Nephrectomy ◽

Da Vinci ◽

Robotic Partial Nephrectomy

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Evaluation of laparoscopic vs robotic partial nephrectomy using the margin, ischemia and complications score system: a retrospective single center analysis

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2015.1.49 ◽

2015 ◽

Vol 87 (1) ◽

pp. 49 ◽

Cited By ~ 4

Author(s):

Stefano Ricciardulli ◽

Qiang Ding ◽

Xu Zhang ◽

Hongzhao Li ◽

Yuzhe Tang ◽

...

Keyword(s):

Partial Nephrectomy ◽

Risk Groups ◽

Matched Pair ◽

P Value ◽

Robotic Partial Nephrectomy ◽

Score System ◽

Operative Outcomes ◽

System A ◽

Binary Regression Analysis ◽

The Relationship

Objective: To evaluate differences between Laparoscopic Partial Nephrectomy (LPN) and Robot-Assisted Partial Nephrectomy (RAPN) using the Margin, Ischemia and Complications (MIC) score system and to evaluate factors related with MIC success. Materials and Methods: Single centre retrospective study on 258 LPN and 58 RAPN performed between January 2012 and January 2014. Success was defined when surgical margins was negative, Warm Ischemia Time (WIT) was ≤ 20 minutes and no major complications occurred. Mann-Whitney-U and Pearson χ2 correlation were used to compare LPN and RAPN. A matched pair comparison was also performed. Spearman correlation (Rho) was used to evaluate the relationship between clinical, intra and post-operative and pathological patients characteristics with MIC score. A binary regression analysis was also performed to evaluate independent factors associated with MIC success. Results: The MIC rate in LPN and RAPN was 55% and 65.5% respectively. No differences in clinical, intra and post-operative outcomes between groups were found. Clinical tumor size (p-value: < 0.001; OR: 0.829; 95% CI: 0.697-0.987), PADUA score (p-value: < 0.001; OR: 0.843; 95% CI: 0.740-0.960), PADUA risk groups (intermediate; p-value: < 0.001; OR: 0.416; 95% CI: 0.238- 0.792; high: p-value: < 0.001; OR: 0.356; 95% CI: 0.199- 0.636), WIT (p-value: < 0.001; OR: 0.598; 95% CI: 0.530- 0.675) were independently associated with MIC. eGFR (< 60 vs ≥ 60 ml/min per 1.73 m2: p-value: < 0.001; OR: 3.356; 95% CI: 1.701-6.621) and Fuhrman nuclear grade (p-value: 0.014; OR: 1.798; 95% CI:1.129-2.865) were also independently associated with MIC. Conclusions: MIC score system is a simple and useful tool to report and to compare different surgical approach.

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Tumor volume and tumor crossing of the axial renal midline predict renal function after robotic partial nephrectomy

Scientific Reports ◽

10.1038/s41598-021-01539-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Haruyuki Ohsugi ◽

Kyojiro Akiyama ◽

Hisanori Taniguchi ◽

Masaaki Yanishi ◽

Motohiko Sugi ◽

...

Keyword(s):

Renal Function ◽

Partial Nephrectomy ◽

Tumor Volume ◽

Characteristic Curve ◽

Three Dimensional ◽

Scoring Systems ◽

Renal Tumors ◽

Perioperative Outcomes ◽

Robotic Partial Nephrectomy ◽

Perioperative Morbidity

AbstractThere are several nephrometry scoring systems for predicting surgical complexity and potential perioperative morbidity. The R.E.N.A.L. scoring system, one of the most well-known nephrometry scoring systems, emphasizes the features on which it is based (Radius, Exophytic/endophytic, Nearness to collecting system or sinus, Anterior/posterior, and Location relative to polar lines). The ability of these nephrometry scoring systems to predict loss of renal function after robotic partial nephrectomy (RPN) remains controversial. Therefore, we verified which combination of factors from nephrometry scoring systems, including tumor volume, was the most significant predictor of postoperative renal function. Patients who underwent RPN for cT1 renal tumors in our hospital were reviewed retrospectively (n = 163). The preoperative clinical data (estimated glomerular filtration rate [eGFR], comorbidities, and nephrometry scoring systems including R.E.N.A.L.) and perioperative outcomes were evaluated. We also calculated the tumor volume using the equation applied to an ellipsoid by three-dimensional computed tomography. The primary outcome was reduced eGFR, which was defined as an eGFR reduction of ≥ 20% from baseline to 6 months after RPN. Multivariable logistic regression analyses were used to evaluate the relationships between preoperative variables and reduced eGFR. Of 163 patients, 24 (14.7%) had reduced eGFR. Multivariable analyses indicated that tumor volume (cutoff value ≥ 14.11 cm3, indicating a sphere with a diameter ≥ approximately 3 cm) and tumor crossing of the axial renal midline were independent factors associated with a reduced eGFR (odds ratio [OR] 4.57; 95% confidence interval [CI] 1.69–12.30; P = 0.003 and OR 3.50; 95% CI 1.30–9.46; P = 0.034, respectively). Our classification system using these two factors showed a higher area under the receiver operating characteristic curve (AUC) than previous nephrometry scoring systems (AUC = 0.786 vs. 0.653–0.719), and it may provide preoperative information for counseling patients about renal function after RPN.

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Perioperative and Oncological Outcomes of 1,002 Consecutive Patients With Localized Renal Cell Carcinoma Treated by Robotic Partial Nephrectomy at a Single Center

The Korean Journal of Urological Oncology ◽

10.22465/kjuo.2021.19.3.183 ◽

2021 ◽

Vol 19 (3) ◽

pp. 183-192

Author(s):

Taejin Kim ◽

Jae Hoon Chung ◽

Hyun Hwan Sung ◽

Hwang Gyun Jeon ◽

Byong Chang Jeong ◽

...

Keyword(s):

Survival Rate ◽

Partial Nephrectomy ◽

Death Rate ◽

Perioperative Outcomes ◽

Robotic Partial Nephrectomy ◽

Recurrence Free Survival ◽

Single Center ◽

Free Survival ◽

Oncological Outcomes

Purpose: To analyze and compare the results of robotic partial nephrectomy (RPN) at a single center with the previous large-scale studies in terms of perioperative and oncological outcomes.Materials and Methods: We retrospectively evaluated 1,013 cases of RPN in our center database from December 2008 to August 2018. Total 11 cases were excluded in final analysis. We evaluated perioperative outcomes as the Trifecta achievement, which is defined as no positive surgical margin (PSM), no perioperative complications greater than Clavien-Dindo classification I and a warm ischemia time of <25 minutes. In addition, we analyzed pathological and oncological outcomes; recurrence, metastasis, all-cause deaths, cancer-specific deaths, and 5-year survival rates.Results: In 1,002 cases, the Trifecta achievement was 61.1% (n=612). The postoperative complication was 18.4% (n=184) but most were grade 2 or less (14.9%, n=145). Ninety-three cases (9.28%) had benign and 907 cases (90.5%) had malignant pathologies. A local recurrence were 14 cases (1.54%) and distant metastasis were 20 cases (2.2%) during follow-up periods. Allcause death rate was 1.2% (n=11) and cancer-specific death rate was 0.2% (n=2). The median follow-up period was 39 months. A 5-year recurrence-free survival rate, cancer-specific survival rate, and overall survival rate were 95.2%, 99.7%, and 98.4%.Conclusions: In summary, our data shows comparable perioperative outcomes to other largescale studies of RPN in terms of the Trifecta achievement with similar baseline characteristics. In terms of oncological outcomes, there was lower rate of PSM and similar recurrence free survival rate.

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