Abstract
Purpose
To analyze the functional and oncologic outcomes of minimally invasive cytoreductive nephrectomy (CN) in three high-volume cancer centers.
Patients and methods
Three prospectively maintained, IRB-approved kidney surgery databases were queried from three high-volume cancer centers. All patients who underwent minimally invasive surgery (laparoscopic, hand-assisted laparoscopic, or robotic) partial or radical CN with existing measurable extra-renal metastatic disease between May 2001 and May of 2013 were included in this analysis.
Results
We identified 120 patients who underwent minimally invasive CN for metastatic renal cell carcinoma. Most of the surgeries were radical (93.3 %) and performed laparoscopically (96.6 %). Median operative time was 210 min, with a median estimated blood loss of 150 cc, and 11 (9.2 %) patients received blood transfusions. Four (3.3 %) patients were converted to open surgery due to locally advanced disease and/or bleeding. Postoperative complications were seen in 28 (23.3 %) patients, of which 20 (71.4 %) were classified as minor (Clavien–Dindo I–II). The median survival of the entire cohort was 25.7 months, with a 3-year survival rate of 35 %. Multivariate analysis indicated that only hypertension, brain metastasis, and pT stage were independently associated with worse overall survival (HR > 1).
Conclusions
Minimally invasive cytoreductive nephrectomy is feasible and safe in experienced hands with acceptable morbidity and oncological outcomes.
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Author’s contribution
L. A. Nunez Bragayrac was involved in project development and data management, analyzed the data, and wrote and edited the manuscript. J. Hoffmeyer was involved in protocol development and data collection and edited the manuscript. D. Abbotoy was involved in data collection and edited the manuscript. K. Attwood was involved in data management and analyzed the data. E. Kauffman was involved in data management and edited the manuscript. P. Spiess was involved in project development and data collection/management and edited the manuscript. A. Wagner was involved in project development and data collection/management and edited the manuscript. T. Schwaab was involved in protocol development and data collection/management, and wrote and edited the manuscript.
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Nunez Bragayrac, L., Hoffmeyer, J., Abbotoy, D. et al. Minimally invasive cytoreductive nephrectomy: a multi-institutional experience. World J Urol 34, 1651–1656 (2016). https://doi.org/10.1007/s00345-016-1827-1
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DOI: https://doi.org/10.1007/s00345-016-1827-1