scholarly journals Comparison of Perioperative, Renal Functional, and Oncological Outcomes Between Off-Clamp and On-Clamp Robot-Assisted Partial Nephrectomy for Renal Tumors: An Updated Evidence-Based Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Yin Huang ◽  
Dehong Cao ◽  
Zeyu Chen ◽  
Bo Chen ◽  
Jin Li ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Complication Rate ◽  
Conversion Rate ◽  
Surgical Margin ◽  
Pooled Analysis ◽  
Renal Tumors ◽  
Positive Surgical Margin ◽  
Transfusion Rate ◽  
Robot Assisted ◽  
Oncological Outcomes

ObjectivesWe aimed to report the latest and largest pooled analysis and evidence update to compare the perioperative, renal functional, and oncological outcomes between off-clamp and on-clamp robot-assisted partial nephrectomy (RAPN) for renal tumors.Patients and methodsWe performed a systematic literature search using PubMed, Embase, and Web of Science up to August 2021 for studies that compared the efficacy and/or safety between off-clamp and on-clamp RAPN for renal tumors. Outcomes measured were operating time, estimated blood loss (EBL), conversion rate, length of stay (LOS), complication rate, transfusion rate, long-term % decrease in estimated glomerular filtration rate (eGFR), positive surgical margin rate, and recurrence rate.ResultsA total of 21 eligible articles involving 4,493 patients (1,274 off-clamp versus 3,219 on-clamp) were included for the evidence synthesis. Baseline characteristics of the two groups were similar in all outcomes except that lower R.E.N.A.L. score and smaller tumor size were observed in the off-clamp group. Pooled analysis showed shorter operative time, higher EBL, and lower complication rate in the off-clamp group. No significant difference was observed in the conversion rate, LOS, and transfusion rate. The recurrence rates were similar in the two groups, while a lower positive surgical margin rate was observed in the off-clamp group. Finally, the off-clamp group had a superior postoperative renal functional outcome.ConclusionsGiven the presence of heterogeneity and potential bias, urologists should select the clamp strategy based on their experience and patient-specific factors.

scholarly journals PENTAFECTA OUTCOME IN INITIAL 30 CASES OF ROBOT ASSISTED PARTIAL NEPHRECTOMY – OUR EXPERIENCE

2020 ◽  
pp. 40-41
Author(s):  
Jeevan Kumar ◽  
Farhana Zakaria ◽  
Altaf Khan ◽  
Lavanya Raghu Sarath P ◽  
Mujeeburahiman M
Keyword(s):  
Partial Nephrectomy ◽  
Surgical Complications ◽  
Surgical Margin ◽  
Warm Ischemia ◽  
Warm Ischemia Time ◽  
Renal Tumors ◽  
Positive Surgical Margin ◽  
Robot Assisted ◽  
Effective Treatment Option ◽  
Ischemia Time

Objectives: To study the Pentafecta outcome of initial 30 cases of Robot Assisted Partial Nephrectomy (RAPN) at our institute. Materials and Methods: A total of 30 patients who underwent Robot assisted partial nephrectomy between January 2016 and June 2018 were prospectively analyzed. The Pentafecta outcome was defined as a warm ischemia time (WIT) of <25 min, negative surgical margins, no surgical complications, > 90% of eGFR preservation & no CKD upstaging. Results: All patients successfully underwent robot assisted partial nephrectomy. Median warm ischemia time was 24.5 minutes. One patient with complex tumour had positive surgical margin. There were no Clavien- Dindo Grade IV and V complications. Grade I-III complications were seen in 20% of patients. Conclusion: RAPN is safe and effective treatment option for renal tumors and it helps in improving pentafecta outcome.

scholarly journals Minimally invasive technologies for surgical treatment of kidney cancer

2021 ◽  
Vol 179 (6) ◽  
pp. 34-43
Author(s):  
S. A. Rakul ◽  
P. N. Romashchenko ◽  
K. V. Pozdnyakov ◽  
N. A. Maistrenko ◽  
R. A. Eloev
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Incidence Rate ◽  
Kidney Cancer ◽  
Surgical Margin ◽  
Tumor Stage ◽  
Positive Surgical Margin ◽  
Robot Assisted ◽  
Kidney Tumors ◽  
Oncological Outcomes

The OBJECTIVE was to analyze the developmental trends, possibilities and outcomes of applying minimally invasive technologies in surgical treatment for kidney cancer.METHODS AnD MATERIALS. The study included 368 surgeries for kidney tumors which were performed from 2012 to 2019. Partial nephrectomy (Pn) was performed in 228 (60.6 %) cases, radical nephrectomy (Rn) – in 148 (39.4 %) cases. Tumors of the stage cT1a detected in 148 (39.4 %), сТ1b – 145 (38.6 %), сT2a – 58 (15.4 %), сТ2b-cTxn1M1 – 25 (6.7 %) patients. Operations were performed using open (3.7 %), laparoscopic (50.3 %), robotic (46.0 %) approaches with assessment of surgical and oncological outcomes of treatment.RESULTS. The incidence rate of Pn in patients with kidney cancer at the stages cT1a, cT1b and cT2a was 89.9, 57.2 and 20.7 %. Rn was performed in all cases of tumor stage сТ2b-cTxn1M1. The frequency of Pn at the stages cT1a, cT1b and cT2a in 2019 exceeded 80 %. Minimally invasive technologies (MIT) for Pn was used in 98.3 %, for Rn – in 92.2 % of cases. The incidence rate of postoperative complications after Pn and Rn at stages сТ1а, сT1b, сТ2а was 14.3and 6.7, 16.9 and 3.2, 16.7 and 2.2 %, respectively. Complications after Rn at tumors of the stage cT2bcTxn1M1 occurred in 20.0 % of patients. Positive surgical margin (PSM) occurred after Pn for tumors of the stage cT1a in 0.7 % of cases; for cT1b – in 2.4 %; for cT2a and after Rn – was not determined.CONCLUSION. Our study demonstrates a steady tendency towards an increase in the number of MIT for kidney tumors, including when performing organ-preserving surgeries. Robot-assisted surgery allows to expand the indications to use a minimally MIT even in the most difficult clinical cases. The frequency of complications after RP compared with Rn is higher because the complexity of the operation increases, and these complications did not affect the outcome of treatment, taking into account the functional advantages provided for patients. The development and widespread introduction of minimally MIT into clinical practice is an evident and inevitable way to develop surgical treatment of kidney cancer.

Retroperitoneal Robot-Assisted Versus Open Partial Nephrectomy for cT1 Renal Tumors: A Matched-Pair Comparison of Perioperative and Early Oncological Outcomes

2018 ◽  
Vol 16 (2) ◽  
pp. e391-e396 ◽  
Author(s):  
Marco Borghesi ◽  
Riccardo Schiavina ◽  
Francesco Chessa ◽  
Lorenzo Bianchi ◽  
Gaetano La Manna ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Renal Tumors ◽  
Matched Pair ◽  
Robot Assisted ◽  
Open Partial Nephrectomy ◽  
Pair Comparison ◽  
Oncological Outcomes

scholarly journals Comparison of early experience laparoscopic versus open partial nephrectomy in terms of clinical, oncological and renal functional outcomes

2021 ◽  
pp. 116-123
Author(s):  
Mert Kılıç ◽  
Meftun Çulpan ◽  
Asıf Yıldırım ◽  
Turhan Çaşkurlu
Keyword(s):  
Local Recurrence ◽  
Partial Nephrectomy ◽  
Functional Outcomes ◽  
Surgical Margin ◽  
Renal Tumors ◽  
Positive Surgical Margin ◽  
Open Partial Nephrectomy ◽  
Renal Functions ◽  
Estimated Blood Loss ◽  
Zero Ischemia

Objective: Although laparoscopic partial nephrectomy (LPN) is minimally invasive, it is also a technically challenging procedure. Currently, open partial nephrectomy (OPN) remains the only alternative in many centers for T1 kidney tumors. We reported our initial experience of LPN compared to OPN regarding clinical, oncological findings and renal functions. Material and Methods: Between 2004-2013, 81 patients who underwent OPN (n=55) or LPN (n=26) for clinically T1 renal tumors were included. Perioperative and postoperative data were compared, retrospectively. Follow-up times for OPN and LPN groups were 72.9± 41.1 and 47.6± 32.4 months, respectively (p<0.05). Results: The mean tumor size and RENAL nephrometry scores were similar for both groups.  Zero-ischemia was performed in all of the LPN and 15% of the OPN procedures. Estimated blood loss and perioperative transfusion rates were higher in OPN group. Complications including grade < 3 and  ≥ 3 did not differ significantly between the groups. The decrease in creatinine-clearance at 6th month was statistically significant in OPN group, while stable in LPN. Positive surgical margin rates were 6.6% for OPN and 17.6% for LPN, p=0.19. One patient in LPN developed local recurrence and underwent nephrectomy. In OPN group,one local recurrence and one distant metastasis were observed in two independent patients. Both patients recieved tyrosine kinase inhibitor. Conclusion: Although LPN is accepted as a technically challenging procedure, LPN provided comparable outcomes to OPN including clinical, oncological findings and renal functions, even in the early learning phase. Zero-ischemia technique for LPN was feasible and safe with favorable perioperative and renal functional outcomes. Keywords: laparoscopy; learning curve; partial nephrectomy; renal cancer; surgical margins; zero-ischemia.

scholarly journals Risk Assessment for Complications of Partial Nephrectomy – Comparative Study between Retroperitoneoscopic Approach and Open Surgery

2017 ◽  
Vol 12 (2) ◽  
pp. 69-73
Author(s):  
Valentin PIRVUT ◽  
◽  
Nicolae GRIGORE ◽  
Adrian HASEGAN ◽  
Ionela MIHAI ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Complication Rate ◽  
Open Surgery ◽  
Renal Tumor ◽  
Intraoperative Complications ◽  
Early Mobilization ◽  
Renal Tumors ◽  
Wound Complications ◽  
Transfusion Rate ◽  
Contralateral Kidney

Introduction. Partial nephrectomy represent the standard of care for small renal tumor. Laproscopic approach tends to replace open surgery due to similar oncologic results, but with better eastethic outcomes and earlier socio-professional reintegration. Material and methods. Between January 2010 and February 2017, 55 patients (p) underwent partial nephrectomy at our center for clinically localized renal tumor, 21p with LPN by retroperitoneal approach and 34p with OPN. All patients had a normal contralateral kidney. The selection of patients for nephron-sparing surgery was based on preoperative CT scan, location of the tumor, the individual general health status of the patient and individual surgeon preferences. Results. The mean age of patients with partial nephrectomy was 59.6±16.4 years, with 57.9±11.6 years for laparoscopic subgroup and 61.3±12.4 for open surgery. The transfusion rate was 9.52% in LPN group, while in the OPN there was no need for transfusion. The warm ischemia time was higher in the LPN group (21.8±7.2 min) than OPN group (15.7±2.9). The postoperative complication rate is comparable between LPN and OPN (23.81% v.s. 20.58%), but the LPN had higher intraoperative complications. Conclusion. Laparoscopic partial nephrectomy for renal tumors is superior to open surgery by early mobilization of the patient, the low rate of wound complications, short duration of hospitalization, fast socio-professional reintegration of patient, despite the perioperative complication rate that is higher but of low ClavienDindo grade.

Sign in / Sign up

Export Citation Format

Share Document