Renal functional outcomes after robotic multiplex partial nephrectomy: the National Cancer Institute experience with robotic partial nephrectomy for 3 or more tumors in a single kidney
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Abstract
Objective
To identify renal function outcomes after robotic multiplex partial nephrectomy (RMxPNx), we reviewed our institutional database at the National Institutes of Health, National Cancer Institute. To our knowledge, we present the largest series of RMxPNx renal function outcomes to date. Robotic partial nephrectomy has been employed for oncologic control and to prevent dialysis dependence in hereditary multifocal renal cell carcinoma conditions. We have termed robotic surgery on a single kidney with three or more lesions a RMxPNx.
Materials and methods
We evaluated patients from a prospectively maintained database at a single institution (NIH/NCI) that underwent RMxPNx from 2007 to 2013. Demographic and operative data were compiled with statistical analysis with T test performed to determine renal function outcomes.
Results
A total of 54 patients underwent RMxPNx. Mean number of tumors removed was 8.63 (range 3–52). Mean preoperative creatinine and eGFR were 1.02 ± 0.26 mg/dL and 85.4 ± 21.5 mL/min, respectively. Postoperatively, creatinine increased from baseline by 0.45 mg/dL (p < 0.001). Similarly, a mean decrease in eGFR by 24.6 mL/min was observed (p < 0.001). At 3-month follow-up, the creatinine increase from baseline was 0.05 mg/dL (p = 0.10) and mean decrease in eGFR was 3.01 mL/min (p = 0.21). When stratifying based on preoperative CKD stages I–III, similar results were observed.
Conclusion
Robotic multiplex partial nephrectomy is a safe and feasible approach to patients with multifocal renal masses. These complex surgeries have a demonstrated learning curve, but this minimally invasive approach for nephron-sparing surgery allows patients to preserve renal function where they would otherwise require open surgery or a radical nephrectomy.
Keywords
Kidney cancer Partial nephrectomy Robotic surgery Multiplex partial nephrectomy Multifocal renal tumorsNotes
Acknowledgments
This research was supported by the Intramural Research Program of the NIH, National Cancer Institute, Center for Cancer Research, and supported by Grant Nos. ZIA1BC011028-05, ZIA BC011038-05, ZIA BC011043-05, ZID BC011089-05 and ZIE BC 011023-05 from the National Institutes of Health.
Compliance and ethical standards
Conflict of interest
None.
Human and animal rights
No animals participated in this study. All human patients involved in urologic care at the NIH consented to the use of the information obtained in this study.
Informed consent
Informed consent was obtained from all individual participants included in the study.
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