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Comparisons of the safety and effectiveness of robot-assisted versus laparoscopic partial nephrectomy for large angiomyolipomas: a propensity score-matched analysis

  • Urology - Original Paper
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Abstract

Objective

To compare the safety and effectiveness of robot-assisted partial nephrectomy (RAPN) versus laparoscopic partial nephrectomy (LPN) for large angiomyolipomas (AMLs).

Materials and methods

We retrospectively evaluated 150 patients who were treated with either RAPN or LPN for large angiomyolipomas from 2014 to 2018. Propensity score matching was performed on age, gender, BMI, Charlson Comorbidity Index, tumour side and size, preoperative eGFR and RENAL score.

Results

In total, 63 and 87 patients underwent RAPNs and LPNs, respectively. There were more large and complex AMLs in the RAPN cohort, with the median tumour maximal diameters and RENAL scores differing between the two groups (8 versus 7 cm and 9 versus 8, P = 0.01). After matching, the median warm ischemic time was significantly shorter in the RAPNs versus the LPNs (17 versus 22 min, P = 0.001). The rate of intraoperative complications in the RAPNs appeared lower than the LPNs (3.2% versus 8.1%). The median postoperative length of stay was significantly shorter in the RAPN cohort than the LPNs (P = 0.001). Twelve months after surgery, RAPNs received a 94.6% renal function prevention; while this was 90.8% in LPNs (P = 0.001). Subgroup analysis indicated that prior selective arterial embolization (SAE) was related to better renal function preservation in the RAPN cohort (P = 0.01). No recurrence occurred in either of the two cohorts.

Conclusions

RAPN is a safe and effective alternative to LPNs for large AMLs with a shorter warm ischemic time and higher renal preservation rate. Recurrence was equivalent in both RAPNs and LPNs.

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Abbreviations

RAPN:

Robot-assisted partial nephrectomy

LPN:

Laparoscopic particularly nephrectomy

SAE:

Selective arterial embolization

AML:

Angiomyolipoma

NSS:

Nephron-sparing surgery

EBL:

Estimated blood loss

WIT:

Warm ischemic time

References

  1. Eble JN (1998) Angiomyolipoma of kidney. Semin Diagn Pathol 15(1):21–40

    CAS  PubMed  Google Scholar 

  2. Wagner BJ, Wong-You-Cheong JJ, Davis CJ Jr (1997) Adult renal hamartomas. Radiogr Rev Publ Radiol Soc N Am Inc 17(1):155–169. https://doi.org/10.1148/radiographics.17.1.9017806

    Article  CAS  Google Scholar 

  3. Lopez-Beltran A, Scarpelli M, Montironi R, Kirkali Z (2006) 2004 WHO classification of the renal tumors of the adults. Eur Urol 49(5):798–805. https://doi.org/10.1016/j.eururo.2005.11.035

    Article  PubMed  Google Scholar 

  4. He W, Cheville JC, Sadow PM, Gopalan A, Fine SW, Al-Ahmadie HA, Chen YB, Oliva E, Russo P, Reuter VE, Tickoo SK (2013) Epithelioid angiomyolipoma of the kidney: pathological features and clinical outcome in a series of consecutively resected tumors. Modern Pathol 26(10):1355–1364. https://doi.org/10.1038/modpathol.2013.72

    Article  Google Scholar 

  5. Nese N, Martignoni G, Fletcher CD, Gupta R, Pan CC, Kim H, Ro JY, Hwang IS, Sato K, Bonetti F, Pea M, Amin MB, Hes O, Svec A, Kida M, Vankalakunti M, Berel D, Rogatko A, Gown AM, Amin MB (2011) Pure epithelioid PEComas (so-called epithelioid angiomyolipoma) of the kidney: a clinicopathologic study of 41 cases: detailed assessment of morphology and risk stratification. Am J Surg Pathol 35(2):161–176. https://doi.org/10.1097/PAS.0b013e318206f2a9

    Article  PubMed  Google Scholar 

  6. Kuusk T, Biancari F, Lane B, Tobert C, Campbell S, Rimon U, D'Andrea V, Mehik A, Vaarala MH (2015) Treatment of renal angiomyolipoma: pooled analysis of individual patient data. BMC Urol 15:123. https://doi.org/10.1186/s12894-015-0118-2

    Article  PubMed  PubMed Central  Google Scholar 

  7. Flum AS, Hamoui N, Said MA, Yang XJ, Casalino DD, McGuire BB, Perry KT, Nadler RB (2016) Update on the diagnosis and management of renal angiomyolipoma. J Urol 195(4 Pt 1):834–846. https://doi.org/10.1016/j.juro.2015.07.126

    Article  PubMed  Google Scholar 

  8. Murray TE, Doyle F, Lee M (2015) Transarterial embolization of angiomyolipoma: a systematic review. J Urol 194(3):635–639. https://doi.org/10.1016/j.juro.2015.04.081

    Article  PubMed  Google Scholar 

  9. Staehler M, Sauter M, Helck A, Linsenmaier U, Weber L, Mayer K, Fischereder M (2012) Nephron-sparing resection of angiomyolipoma after sirolimus pretreatment in patients with tuberous sclerosis. Int Urol Nephrol 44(6):1657–1661. https://doi.org/10.1007/s11255-012-0292-z

    Article  PubMed  Google Scholar 

  10. Castle SM, Gorbatiy V, Ekwenna O, Young E, Leveillee RJ (2012) Radiofrequency ablation (RFA) therapy for renal angiomyolipoma (AML): an alternative to angio-embolization and nephron-sparing surgery. BJU Int 109(3):384–387. https://doi.org/10.1111/j.1464-410X.2011.10376.x

    Article  PubMed  Google Scholar 

  11. Ljungberg B, Albiges L, Abu-Ghanem Y, Bensalah K, Dabestani S, Fernandez-Pello S, Giles RH, Hofmann F, Hora M, Kuczyk MA, Kuusk T, Lam TB, Marconi L, Merseburger AS, Powles T, Staehler M, Tahbaz R, Volpe A, Bex A (2019) European Association of Urology Guidelines on renal cell carcinoma: the 2019 update. Eur Urol 75(5):799–810. https://doi.org/10.1016/j.eururo.2019.02.011

    Article  PubMed  Google Scholar 

  12. Ramon J, Rimon U, Garniek A, Golan G, Bensaid P, Kitrey ND, Nadu A, Dotan ZA (2009) Renal angiomyolipoma: long-term results following selective arterial embolization. Eur Urol 55(5):1155–1161. https://doi.org/10.1016/j.eururo.2008.04.025

    Article  PubMed  Google Scholar 

  13. Msezane L, Chang A, Shikanov S, Deklaj T, Katz MH, Shalhav AL, Lifshitz DA (2010) Laparoscopic nephron-sparing surgery in the management of angiomyolipoma: a single center experience. J Endourol 24(4):583–587. https://doi.org/10.1089/end.2009.0330

    Article  PubMed  Google Scholar 

  14. Golan S, Johnson SC, Maurice MJ, Kaouk JH, Lai WR, Lee BR, Kheyfets SV, Sundaram CP, Cahn DB, Uzzo RG, Shalhav AL (2017) Safety and early effectiveness of robot-assisted partial nephrectomy for large angiomyolipomas. BJU Int 119(5):755–760. https://doi.org/10.1111/bju.13747

    Article  PubMed  Google Scholar 

  15. Kutikov A, Uzzo RG (2009) The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182(3):844–853. https://doi.org/10.1016/j.juro.2009.05.035

    Article  PubMed  Google Scholar 

  16. Fornara P (2008) Editorial comment on: robotic partial nephrectomy for complex renal tumors: surgical technique. Eur Urol 53(3):522–523. https://doi.org/10.1016/j.eururo.2007.09.049

    Article  PubMed  Google Scholar 

  17. Sooriakumaran P, Gibbs P, Coughlin G, Attard V, Elmslie F, Kingswood C, Taylor J, Corbishley C, Patel U, Anderson C (2010) Angiomyolipomata: challenges, solutions, and future prospects based on over 100 cases treated. BJU Int 105(1):101–106. https://doi.org/10.1111/j.1464-410X.2009.08649.x

    Article  PubMed  Google Scholar 

  18. Ouzaid I, Autorino R, Fatica R, Herts BR, McLennan G, Remer EM, Haber GP (2014) Active surveillance for renal angiomyolipoma: outcomes and factors predictive of delayed intervention. BJU Int 114(3):412–417. https://doi.org/10.1111/bju.12604

    Article  PubMed  Google Scholar 

  19. Benway BM, Bhayani SB, Rogers CG, Dulabon LM, Patel MN, Lipkin M, Wang AJ, Stifelman MD (2009) Robot assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal tumors: a multi-institutional analysis of perioperative outcomes. J Urol 182(3):866–872. https://doi.org/10.1016/j.juro.2009.05.037

    Article  PubMed  Google Scholar 

  20. Bravi CA, Larcher A, Capitanio U, Mari A, Antonelli A, Artibani W, Barale M, Bertini R, Bove P, Brunocilla E, Da Pozzo L, Di Maida F, Fiori C, Gontero P, Li Marzi V, Longo N, Mirone V, Montanari E, Porpiglia F, Schiavina R, Schips L, Simeone C, Siracusano S, Terrone C, Trombetta C, Volpe A, Montorsi F, Ficarra V, Carini M, Minervini A (2019) Perioperative outcomes of open, laparoscopic, and robotic partial nephrectomy: a prospective multicenter observational study (The RECORd 2 Project). Eur Urol Focus. https://doi.org/10.1016/j.euf.2019.10.013

    Article  PubMed  Google Scholar 

  21. Leow JJ, Heah NH, Chang SL, Chong YL, Png KS (2016) Outcomes of robotic versus laparoscopic partial nephrectomy: an updated meta-analysis of 4919 patients. J Urol 196(5):1371–1377. https://doi.org/10.1016/j.juro.2016.06.011

    Article  PubMed  Google Scholar 

  22. Choi JE, You JH, Kim DK, Rha KH, Lee SH (2015) Comparison of perioperative outcomes between robotic and laparoscopic partial nephrectomy: a systematic review and meta-analysis. Eur Urol 67(5):891–901. https://doi.org/10.1016/j.eururo.2014.12.028

    Article  PubMed  Google Scholar 

  23. Faria EF, Caputo PA, Wood CG, Karam JA, Nogueras-Gonzalez GM, Matin SF (2014) Robotic partial nephrectomy shortens warm ischemia time, reducing suturing time kinetics even for an experienced laparoscopic surgeon: a comparative analysis. World J Urol 32(1):265–271. https://doi.org/10.1007/s00345-013-1115-2

    Article  PubMed  Google Scholar 

  24. Khalifeh A, Autorino R, Hillyer SP, Laydner H, Eyraud R, Panumatrassamee K, Long JA, Kaouk JH (2013) Comparative outcomes and assessment of trifecta in 500 robotic and laparoscopic partial nephrectomy cases: a single surgeon experience. J Urol 189(4):1236–1242. https://doi.org/10.1016/j.juro.2012.10.021

    Article  PubMed  Google Scholar 

  25. Rosen DC, Kannappan M, Paulucci DJ, Beksac AT, Attalla K, Abaza R, Eun DD, Bhandari A, Hemal AK, Porter J, Badani KK (2018) Reevaluating warm ischemia time as a predictor of renal function outcomes after robotic partial nephrectomy. Urology 120:156–161. https://doi.org/10.1016/j.urology.2018.06.019

    Article  PubMed  Google Scholar 

  26. Boorjian SA, Frank I, Inman B, Lohse CM, Cheville JC, Leibovich BC, Blute ML (2007) The role of partial nephrectomy for the management of sporadic renal angiomyolipoma. Urology 70(6):1064–1068. https://doi.org/10.1016/j.urology.2007.07.045

    Article  PubMed  Google Scholar 

  27. Papalia R, Simone G, Ferriero M, Guaglianone S, Costantini M, Giannarelli D, Maini CL, Forastiere E, Gallucci M (2012) Laparoscopic and robotic partial nephrectomy without renal ischaemia for tumours larger than 4 cm: perioperative and functional outcomes. World J Urol 30(5):671–676. https://doi.org/10.1007/s00345-012-0961-7

    Article  PubMed  Google Scholar 

  28. Choi SY, Jung H, You D, Jeong IG, Song C, Hong B, Hong JH, Ahn H, Kim CS (2019) Robot-assisted partial nephrectomy is associated with early recovery of renal function: comparison of open, laparoscopic, and robot-assisted partial nephrectomy using DTPA renal scintigraphy. J Surg Oncol 119(7):1016–1023. https://doi.org/10.1002/jso.25429

    Article  CAS  PubMed  Google Scholar 

  29. Seyam RM, Alkhudair WK, Kattan SA, Alotaibi MF, Alzahrani HM, Altaweel WM (2017) The risks of renal angiomyolipoma: reviewing the evidence. J Kidney Cancer VHL 4(4):13–25. https://doi.org/10.15586/jkcvhl.2017.97

    Article  PubMed  PubMed Central  Google Scholar 

  30. Lee KH, Tsai HY, Kao YT, Lin HC, Chou YC, Su SH, Chuang CK (2019) Clinical behavior and management of three types of renal angiomyolipomas. J Formosan Med Assoc 118(1 Pt 1):162–169. https://doi.org/10.1016/j.jfma.2018.02.012

    Article  PubMed  Google Scholar 

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Acknowledgements

We appreciate Xiaozhi zhao for his great help with the manuscript.

Funding

This work was supported by the Natural Science Fund of China (81502203 and 81572519), program for Science and Technology Plan in Nanjing (201503014) and the Fundamental Research Fund for the Central Universities (021414380058, 021414380041 and 021414380089).

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Author notes

  1. Shengjie Zhang, Tingsheng Lin and Guangxiang Liu equal study contribution.

Authors and Affiliations

  1. Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, Jiangsu, People’s Republic of China

    Shengjie Zhang, Tingsheng Lin, Guangxiang Liu, Shiwei Zhang & Hongqian Guo

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  1. Shengjie Zhang
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  2. Tingsheng Lin
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  4. Shiwei Zhang
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Contributions

SJZ: project development, data collection, manuscript writing. TSL: project development. GXL: project development. SWZ: management. GHQ: project development.

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Correspondence to Hongqian Guo.

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Zhang, S., Lin, T., Liu, G. et al. Comparisons of the safety and effectiveness of robot-assisted versus laparoscopic partial nephrectomy for large angiomyolipomas: a propensity score-matched analysis. Int Urol Nephrol 52, 1675–1682 (2020). https://doi.org/10.1007/s11255-020-02441-x

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