Abstract
To determine whether the approach for partial nephrectomy is influenced by tumor complexity and if the introduction of robotic techniques has allowed us to treat more complex tumors minimally invasively. Data from 292 patients who underwent partial nephrectomy for renal masses from November 1999 to July 2013 at a tertiary referral center were retrospectively reviewed. Nephrometry scores and perioperative outcomes were stratified based on when robotic techniques were introduced. Mean follow-up time was 2.6 years. Preoperative RENAL nephrometry scores and perioperative outcomes were analyzed. Of the 292 patients, 31.5 % underwent robot-assisted partial nephrectomy, 46.2 % laparoscopic partial nephrectomy and 22.9 % open partial nephrectomy. Robot-assisted partial nephrectomy mean nephrometry score was significantly higher than laparoscopic and equivalent to open. Significant perioperative differences were estimated blood loss (p = 0.0001), length of stay (p = 0.0001) and Clavien score (p = 0.0069), all favoring robot-assisted partial nephrectomy. Limitations include retrospective design and single center data. Robot-assisted partial nephrectomy is a safe and effective surgical modality that allows for complex renal tumors that were previously reserved for open partial nephrectomy in the pure laparoscopic era to be managed with a minimally invasive approach.
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References
Ljungberg B, Bensalah K, Bex A et al (2013) Guidelines on renal cell carcinoma, renal cell carcinoma: update march 2013. European Association of Urology, Milan
Patard JJ, Pantuck AJ, Crepel M et al (2007) Morbidity and clinical outcome of nephron-sparing surgery in relation to tumour size and indication. Eur Urol 52:148–154
Campbell SC, Novick AC, Belldegrun A et al (2009) Guideline for management of the clinical T1 renal mass. J Urol 182:1271–1279
Patard JJ, Shvarts O, Lam JS et al (2004) Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience. J Urol 171:2181–2185
Huang WC, Levey AS, Serio AM et al (2006) Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol 7:735–740
Minervini A, Siena G, Carini M (2011) Robotic-assisted partial nephrectomy: the next gold standard for the treatment of intracapsular renal tumors. Expert Rev Anticancer Ther 11:1779–1782
Gill IS, Kavoussi LR, Lane BR et al (2007) Comparison of 1800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 178:41–46
Lane BR, Gill IS (2007) 5-Year outcomes of laparoscopic partial nephrectomy. J Urol 177:70–74 (discussion 74)
Aboumarzouk OM, Stein RJ, Eyraud R et al (2012) Robotic versus laparoscopic and partial nephrectomy: a systematic review and meta-analysis. Eur Urol 62(6):1023–1033
Froghi S, Ahmed K, Khan MS et al (2013) Evaluation of robotic and laparoscopic partial nephrectomy for small renal tumours (T1a). BJU Int 112:E322–E333
Petros F, Sukumar S, Haber GP et al (2012) Multi Institutional analysis of robot- and assisted partial nephrectomy for renal tumors >4 cm versus <4 cm in 445 consecutive patients. J Endourol 26:642–646
Ghani KR, Sukumar S, Sammon JD et al (2013) Practice patterns and outcomes of open and minimally invasive partial nephrectomy since the introduction of robotic partial nephrectomy: results from the nationwide inpatient sample. J Urol 191(4):907–912. doi:10.1016/j.juro.2013.10.099
Kutikov A, Uzzo RG (2009) The RENAL nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182(3):844–853
Simon SD, Castle EP, Ferrigni RG et al (2004) Complications of laparoscopic nephrectomy: the Mayo Clinic experience. J Urol 171(4):1447–1450
Desai PJ, Andrews PE, Ferrigni RG et al (2008) Laparoscopic partial nephrectomy at the Mayo Clinic Arizona: follow-up surveillance of positive margin disease. Urology 71(2):283–286
Levey SA, Stevens LA, Schmid CH et al (2009) CKD-EPI (chronic kidney disease epidemiology collaboration); a new equation to estimate glomerular filtration rate. Ann Intern Med 150(9):604–612
Stevens LA, Schmid CH, Greene T et al (2010) Comparative performance of the CKD epidemiology collaboration (CKD-EPI) and the modification of diet in renal disease (MDRD) study equations for estimating GFR levels above 60 mL/min/1.73 m2. Am J Kidney Dis 56(3):486–495 (ISSN 0272-6386)
Hollenbeck BK, Taub DA, Miller DC et al (2006) National utilization trends of partial nephrectomy for renal cell carcinoma: a case of underutilization? Urology 67:254–259
Acknowledgments
We would like to thank Desert Mountain’s C.A.R.E (Cancer Awareness Through Research and Education) organization for its generous support of the genitourinary research program at Mayo Clinic, Scottsdale, Arizona. The authors would also like to acknowledge the support provided by the Gloria A. and Thomas J. Dutson, Jr. Kidney Research Endowment.
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Authors Patton, Salevitz, Tyson, Andrews, Ferrigni, Nateras and Castle declare that they have no conflict of interest.
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IRB approved protocol number: 13-002688.
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Patton, M.W., Salevitz, D.A., Tyson, M.D. et al. Robot-assisted partial nephrectomy for complex renal masses. J Robotic Surg 10, 27–31 (2016). https://doi.org/10.1007/s11701-015-0554-8
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DOI: https://doi.org/10.1007/s11701-015-0554-8