Comparison of robotic and open partial nephrectomy for highly complex renal tumors (RENAL nephrometry score ≥10)

Background and Objective: Open partial nephrectomy (PN) is still considered gold standard procedure for T1 localized renal tumors. Conventional technique involves clamping of the renal artery with or without vein however, renal ischemia produces a certain level of damage to the kidneys. This study aims to investigate potential effect of off-clamp vs. hilar clamping PN on renal function. Methods: This is a retrospective cohort study of patients who underwent unilateral, open partial nephrectomy for renal tumors b/w January 2009 December 2016 at our institution. A total of 90 partial nephrectomies were performed of which 65 cases were eligible for analysis. Non clamping technique was used in 43 while clamp was applied in 22 patients. Variables studied were patients’ demographics, clinical variables, the laterality, tumors size and location, R.E.N.A.L nephrometry score, blood loss, tumor histology and surgical margins. Patients’ renal function (serum creatinine and eGFR) were determined pre-operatively, at 3 and 12 months follow up. Data was analyzed on SPSS v. 22. Results: Both the groups were comparable with regards to pre-operative renal function. Mean radiological size of tumor was 4.71±1.31 and 3.81±1.0 (0.003) in two groups respectively. Mean R.E.N.A.L nephrometry score was 6.1±1.5 in off-clamp group compared to 7.05±1.7 in clamp group (p=0.04). No statistically significant difference was found in operative duration, blood loss, positive surgical margins and intra/ peri-operative complications. At three months and one year, renal function was better preserved in non-clamp group compared to clamp group (p=0.001 and 0.007 respectively). Conclusion: Off clamp open partial nephrectomy is safe and feasible option leading to less decline in renal function. doi: https://doi.org/10.12669/pjms.36.3.1533 How to cite this:Jalbani IK, Nazim SM, Ahmed M, Abbas F. Nephron sparing surgery for renal tumors- comparison of off-clamp partial nephrectomy with hilar clamping. Pak J Med Sci. 2020;36(3):---------. doi: https://doi.org/10.12669/pjms.36.3.1533 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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PROSPECTIVE RANDOMIZED STUDY COMPARING LAPAROSCOPIC AND OPEN PARTIAL NEPHRECTOMY FOR TREATMENT OF RENAL TUMORS: SURGICAL AND FUNCTIONAL OUTCOMES

Zagazig University Medical Journal ◽

10.21608/zumj.2020.46924.1978 ◽

2020 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

Ahmed Tantaway ◽

Mahmoud Eladl ◽

Ahmed Shoma ◽

Ahmed Ali

Keyword(s):

Partial Nephrectomy ◽

Functional Outcomes ◽

Randomized Study ◽

Renal Tumors ◽

Prospective Randomized Study ◽

Open Partial Nephrectomy

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Laparoscopic versus open partial nephrectomy for the management of highly complex renal tumors with PADUA score ⩾10: A single center analysis.

Urologia Journal ◽

10.1177/03915603211001677 ◽

2021 ◽

pp. 039156032110016

Author(s):

Francesco Chiancone ◽

Marco Fabiano ◽

Clemente Meccariello ◽

Maurizio Fedelini ◽

Francesco Persico ◽

...

Keyword(s):

Partial Nephrectomy ◽

Operation Time ◽

Renal Tumors ◽

Open Partial Nephrectomy ◽

Estimated Blood Loss ◽

Significant Difference ◽

Operative Complications ◽

Group A ◽

Group B ◽

Post Operative Complications

Introduction: The aim of this study was to compare laparoscopic and open partial nephrectomy (PN) for renal tumors of high surgical complexity (PADUA score ⩾10). Methods: We retrospectively evaluated 93 consecutive patients who underwent PN at our department from January 2015 to September 2019. 21 patients underwent open partial nephrectomy (OPN) (Group A) and 72 underwent laparoscopic partial nephrectomy (LPN) (Group B). All OPNs were performed with a retroperitoneal approach, while all LPNs were performed with a transperitoneal approach by a single surgical team. Post-operative complications were classified according to the Clavien-Dindo system. Results: The two groups showed no difference in terms of patients’ demographics as well as tumor characteristics in all variables. Group A was found to be similar to group B in terms of operation time ( p = 0.781), conversion to radical nephrectomy ( p = 0.3485), and positive surgical margins ( p = 0.338) while estimated blood loss ( p = 0.0205), intra-operative ( p = 0.0104), and post-operative ( p = 0.0081) transfusion rates, drainage time ( p = 0.0012), pain score at post-operative day 1 (<0.0001) were significantly lower in Group B. The rate of enucleation and enucleoresection/polar resection was similar ( p = 0.1821) among the groups. Logistic regression analysis indicated that preoperative factors were not independently associated with the surgical approach. There was a statistically significant difference in complication rate (<0.0001) between the two groups even if no significant difference in terms of grade ⩾3 post-operative complications ( p = 0.3382) was detected. Discussion: LPN represents a feasible and safe approach for high complex renal tumors if performed in highly experienced laparoscopic centers. This procedure offers good intraoperative outcomes and a low rate of post-operative complications.

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Association between R.E.N.A.L nephrometry score and perioperative outcomes following open partial nephrectomy under cold ischemia

Canadian Urological Association Journal ◽

10.5489/cuaj.1372 ◽

2014 ◽

Vol 8 (3-4) ◽

pp. 137

Author(s):

Dong Soo Park ◽

Jin Ho Hwang ◽

Moon Hyung Kang ◽

Jong Jin Oh

Keyword(s):

Blood Loss ◽

Partial Nephrectomy ◽

Perioperative Outcomes ◽

Renal Neoplasm ◽

Cold Ischemia ◽

Ischemic Time ◽

Open Partial Nephrectomy ◽

Cold Ischemic Time ◽

Nephrometry Score ◽

Estimated Blood Loss

Introduction: We investigate the clinical significance of the R.E.N.A.L. nephrometry score for renal neoplasm following open partial nephrectomy (PN) under cold ischemia.Methods: A retrospective analysis was conducted using clinical data of 98 consecutive patients with clear cell renal cell carcinoma who underwent open PN by a single surgeon from December 2000 to September 2012. Tumour complexity was stratified into 3 categories: low (4-6), moderate (7-9) and high (10-12) complexity. Perioperative outcomes, such as complications, cold ischemic time, estimated blood loss and renal function, were analyzed according to the complexity by NS. Complications were stratified using the Clavien-Dindo classification system.Results: Tumour complexity according to nephrometry score was assessed as low in 16 (16.3%), moderate in 48 (49.0%) and high in 34 (34.7%). The median cold ischemic time did not differ significantly among the 3 groups (36.0 minutes in low-, 40 minutes in moderate- and 43 minutes in the high-complexity group, p = 0.421). Total complications did not differ significantly (2 (2.0%) in low, 4 (4.1%) in moderate and 4 (4.1%) in high, p = 0.984). Each Grade 3 complication occurred in the moderate (urine leakage) and high groups (lymphocele). Postoperative renal functional outcomes were similar among the groups (p = 0.729). Only mean estimated blood loss was significantly different with nephrometry score (p = 0.049).Conclusions: The nephrometry score, as used in an open PN series under cold ischemia, was not significantly associated with perioperative outcomes (i.e., ischemia time, complications, renal functional preservation).

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Comparison of Perioperative Outcomes of Robotic Versus Laparoscopic Partial Nephrectomy for Complex Renal Tumors (RENAL Nephrometry Score of 7 or Higher)

Korean Journal of Urology ◽

10.4111/kju.2014.55.12.808 ◽

2014 ◽

Vol 55 (12) ◽

pp. 808 ◽

Cited By ~ 17

Author(s):

Hyeon Jun Jang ◽

Wan Song ◽

Yoon Seok Suh ◽

U Seok Jeong ◽

Hwang Gyun Jeon ◽

...

Keyword(s):

Partial Nephrectomy ◽

Laparoscopic Partial Nephrectomy ◽

Renal Tumors ◽

Perioperative Outcomes ◽

Nephrometry Score

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Cost comparison of robotic, laparoscopic, and open partial nephrectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.5_suppl.394 ◽

2012 ◽

Vol 30 (5_suppl) ◽

pp. 394-394

Author(s):

Mehrdad Alemozaffar ◽

Steven Lee Chang ◽

Ravi Kacker ◽

Maryellen Sun ◽

William C DeWolf ◽

...

Keyword(s):

Sensitivity Analysis ◽

Hospital Stay ◽

Partial Nephrectomy ◽

Hospital Costs ◽

Cost Comparison ◽

Renal Tumors ◽

Robotic Partial Nephrectomy ◽

Fixed Costs ◽

Average Hospital ◽

Open Partial Nephrectomy

394 Background: Laparoscopic and robotic partial nephrectomy (LPN and RPN) are increasingly common minimally invasive alternatives to open partial nephrectomy (OPN) for management of renal tumors. The cost discrepancies of these approaches warrants evaluation. We compared hospital costs associated with RPN, LPN, and OPN. Methods: Variable hospital costs including operating room (OR) time, supplies, anesthesia, inpatient care, radiology, pharmacy, and laboratory charges were captured for 25 patients who underwent OPN, LPN, and RPN at our institution between 11/2008 -9/2010. Fixed costs of acquisition of a laparoscopic suite and a robotic system (including maintenance) were amortized over 7 years. We considered alternative scenarios through one-way and multi-way sensitivity analysis. Results: We found similar overall variable costs for OPN, LPN, and RPN. Sensitivity analysis demonstrated that RPN and LPN are more cost effective than OPN (excluding fixed costs) if the average hospital stay is < 2 days, or OR time less is than 204 and 196 mins, respectively. By including fixed costs of equipment, RPN and LPN are always more costly than OPN. Conclusions: There was no difference among variable hospital costs of OPN, LPN, and RPN. Minimizing OR time and hospital stay reduces RPN and LPN costs to levels comparable to OPN. Inclusion of fixed costs makes LPN and RPN more expensive than OPN, but increased utilization and efficiency can decrease cost per case. [Table: see text]

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