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Perioperative outcomes following robot-assisted partial nephrectomy in elderly patients

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Abstract

Objective

To compare perioperative outcomes following robot-assisted partial nephrectomy (RAPN) in patients with age ≥ 70 years to age < 70 years.

Methods

Using Vattikuti Collective quality initiative (VCQI) database for RAPN we compared perioperative outcomes following RAPN between the two age groups. Primary outcome of the study was to compare trifecta outcomes between the two groups. Propensity matching using nearest neighbourhood method was performed with trifecta as primary outcome for sex, body mass index (BMI), solitary kidney, tumor size and Renal nephrometery score (RNS).

Results

Group A (age ≥ 70 years) included 461 patients whereas group B included 1932 patients. Before matching the two groups were statistically different for RNS and solitary kidney rates. After propensity matching, the two groups were comparable for baselines characteristics such as BMI, tumor size, clinical symptoms, tumor side, face of tumor, solitary kidney and tumor complexity. Among the perioperative outcome parameters there was no difference between two groups for operative time, blood loss, intraoperative transfusion, intraoperative complications, need for radical nephrectomy, positive margins and trifecta rates. Warm ischemia time was significantly longer in the younger age group (18.1 min vs. 16.3 min, p = 0.003). Perioperative complications were significantly higher in the older age group (11.8% vs. 7.7%, p = 0.041). However, there was no difference between the two groups for major complications.

Conclusion

RAPN in well-selected elderly patients is associated with comparable trifecta outcomes with acceptable perioperative morbidity.

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Data availability statement

Corresponding author had full access to data and same can be provided on request to genuine authors.

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Acknowledgements

Vattikuti Foundation for providing data. The authors would also like to thank Mrs. Tanvi Sharma (M Phil English) for English language editing

Author information

Authors and Affiliations

  1. Department of Urologic Oncology, Max Institute of Cancer Care, Saket, New Delhi, India

    Gopal Sharma, Milap Shah, Puneet Ahluwalia & Gagan Gautam

  2. King’s Health Partners, King’s College, London, UK

    Prokar Dasgupta

  3. Guys and St Thomas’ Hospital, London, UK

    Benjamin J. Challacombe

  4. Vattikuti Foundation, Detroit, MI, USA

    Mahendra Bhandari

  5. The Medicity Hospital, New Delhi, India

    Rajesh Ahlawat

  6. Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India

    Sudhir Rawal

  7. Humanitas Research Hospital, Rozzano, MI, Italy

    Nicolo M. Buffi

  8. Chennai Urology and Robotics Institute, Chennai, India

    Ananthakrishanan Sivaraman

  9. Swedish Medical Center, Seattle, WA, USA

    James R. Porter

  10. Henry Ford Hospital, Detroit, MI, USA

    Craig Rogers

  11. ORSI Academy, Melle, Belgium

    Alexandre Mottrie

  12. Central Ohio Urology Group and Mount Carmel Health System Prostate Cancer Program, Columbus, OH, USA

    Ronney Abaza

  13. Yonsei University Health System, Seoul, South Korea

    Khoon Ho Rha

  14. Peter MacCallum Cancer Centre, Royal Melbourne Clinical School, University of Melbourne, Melbourne, Australia

    Daniel Moon

  15. Kokilaben Dhirubhai Ambani Hospital, Mumbai, India

    Thyavihally B. Yuvaraja

  16. University of Miami Health System, Miami, FL, USA

    Dipen J. Parekh

  17. Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy

    Umberto Capitanio

  18. Center for Robotic and Minimally Invasive Surgery, Hospital Da Luz, Luz Sáude, Portugal

    Kris K. Maes

  19. San Luigi Gonzaga Hospital of Orbassano, Turin, Italy

    Francesco Porpiglia

  20. Department of Urology, Altunizade Hospital, Acıbadem M.A., Aydınlar University, Istanbul, Turkey

    Levent Turkeri

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  1. Gopal Sharma
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Contributions

All the authors were involved in data acquisition and manuscript editing. GS, MS, PA & GG were involved in conception, design, analysis, manuscript writing and editing. G.G was involved in supervision of the project.

Corresponding author

Correspondence to Gagan Gautam.

Ethics declarations

Conflict of interest

Ronney Abaza is a speaker for Intuitive surgical, Conmed Inc and VTI. Benjamin J Challacombe, Kris K Maes, Rajesh Ahlawat and Gagan Gautam are proctors for Intuitive surgical. Other authors report no conflict of interests.

Research involving human participants and/or animals

This study is retrospective analysis of VCQI database and ethics approval was obtained from all the participating centers prior to data collection.

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Need for consent waived off by ethics committee.

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Sharma, G., Shah, M., Ahluwalia, P. et al. Perioperative outcomes following robot-assisted partial nephrectomy in elderly patients. World J Urol 40, 2789–2798 (2022). https://doi.org/10.1007/s00345-022-04171-4

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  • DOI: https://doi.org/10.1007/s00345-022-04171-4

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