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American Confederation of Urology (CAU) experience in minimally invasive partial nephrectomy

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Abstract

Purpose

To describe the perioperative and oncology outcomes in a series of laparoscopic or robotic partial nephrectomies (PN) for renal tumors treated in diverse institutions of Hispanic America from the beginning of their minimally invasive (MI) PN experience through December 2014.

Methods

Seventeen institutions participated in the CAU generated a MI PN database. We estimated proportions, medians, 95 % confidence intervals, Kaplan–Meier curves, multivariate logistic and Cox regression analyses. Clavien–Dindo classification was used.

Results

We evaluated 1501 laparoscopic (98 %) or robotic (2 %) PNs. Median age: 58 years. Median surgical time, warm ischemia and intraoperative bleeding were 150, 20 min and 200 cc. 81 % of the lesions were malignant, with clear cell histology being 65 % of the total. Median maximum tumor diameter is 2.7 cm, positive margin is 8.2 %, and median hospitalization is 3 days. One or more postoperative complication was recorded in 19.8 % of the patients: Clavien 1: 5.6 %; Clavien 2: 8.4 %; Clavien 3A: 1.5 %; Clavien 3B: 3.2 %; Clavien 4A: 1 %; Clavien 4B: 0.1 %; Clavien 5: 0 %. Bleeding was the main cause of a reoperation (5.5 %), conversion to radical nephrectomy (3 %) or open partial nephrectomy (6 %). Transfusion rate is 10 %. In multivariate analysis, RENAL nephrometry score was the only variable associated with complications (OR 1.1; 95 % CI 1.02–1.2; p = 0.02). Nineteen patients presented disease progression or died of disease in a median follow-up of 1.37 years. The 5-year progression or kidney cancer mortality-free rate was 94 % (95 % CI 90, 97). Positive margins (HR 4.98; 95 % CI 1.3–19; p = 0.02) and females (HR 5.6; 95 % CI 1.7–19; p = 0.005) were associated with disease progression or kidney cancer mortality after adjusting for maximum tumor diameter.

Conclusion

Laparoscopic PN in these centers of Hispanic America seem to have acceptable perioperative complications and short-term oncologic outcomes.

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Acknowledgments

The uninterested collaboration of Dr. Ricardo Favaretto (Urologist at AC Camargo Cancer Center) and Dr. Fernando Caumont (Alexander Fleming Institute) is gratefully acknowledged as well as the support of the different working groups of the American Confederation of Urology (CAU). The first author thanks Sir Eduardo Eurnekian, president of America Corporation, for his help and support.

Author information

Authors and Affiliations

  1. San Lázaro and FUNDES Foundation, Buenos Aires, Argentina

    Fernando P. Secin

  2. Clínica INDISA and Universidad Andrés Bello, Santiago, Chile

    Octavio A. Castillo, Ivar Vidal-Mora & Oscar Schatloff

  3. British and Austral Hospital, Buenos Aires, Argentina

    José J. Rozanec, Marcelo Featherston & Pablo Holst

  4. Urology Institute, Porto Alegre, Brazil

    José Cocisfran Alves Milfont & Victor Teixeira Dubeux

  5. Italian Hospital, Buenos Aires, Argentina

    Patricio García Marchiñena & Alberto Jurado Navarro

  6. CEMIC University Hospital, Buenos Aires, Argentina

    Fernando P. Secin, Anamaría Autrán & Agustín R. Rovegno

  7. Puigvert Foundation, Barcelona, Spain

    Oscar Rodríguez Faba, Joan Palou & Humberto Villavicencio Mavric

  8. Centro de Cirugía Robótica y de Invasión Mínima (C.I.M.I.), Caracas, Venezuela

    Luciano Nuñez Bragayrac & Rene Sotelo

  9. AC Camargo Cancer Center, São Paulo, Brazil

    Stenio Zequi & Gustavo Cardoso Guimarães

  10. Infanta Sofía Hospital, Madrid, Spain

    Mario Álvarez-Maestro & Luis Martínez-Piñeiro

  11. Alexander Fleming Institute, Buenos Aires, Argentina

    Gustavo Villoldo & Alberto Villaronga

  12. Pasteur Hospital, Montevideo, Uruguay

    Diego Abreu Clavijo & Ricardo Decia

  13. Quinta Dor and Samaritano Hospital, Rio de Janeiro, Brazil

    Rodrigo Frota

  14. Hospital de Trauma Dr. F. Abete, Buenos Aires, Argentina

    Diana Finkelstein & Juan I. Monzó Gardiner

  15. HoPe Urología, Tijuana, Mexico

    Andres Hernández-Porrás

  16. La Raza Hospital, Mexico city, Mexico

    Félix Santaella-Torres

  17. Mater Dei Hospital, Buenos Aires, Argentina

    Emilio T. Quesada

  18. Hospital Universitario de Caracas, Caracas, Venezuela

    Rodolfo Sánchez-Salas & Hugo Dávila

Authors
  1. Fernando P. Secin
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  2. Octavio A. Castillo
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  3. José J. Rozanec
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  4. Marcelo Featherston
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  6. José Cocisfran Alves Milfont
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  18. Mario Álvarez-Maestro
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  23. Ricardo Decia
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  24. Rodrigo Frota
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  28. Oscar Schatloff
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  29. Andres Hernández-Porrás
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  30. Félix Santaella-Torres
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  31. Emilio T. Quesada
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  32. Rodolfo Sánchez-Salas
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  33. Hugo Dávila
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  34. Humberto Villavicencio Mavric
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Corresponding author

Correspondence to Fernando P. Secin.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Secin, F.P., Castillo, O.A., Rozanec, J.J. et al. American Confederation of Urology (CAU) experience in minimally invasive partial nephrectomy. World J Urol 35, 57–65 (2017). https://doi.org/10.1007/s00345-016-1837-z

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  • DOI: https://doi.org/10.1007/s00345-016-1837-z

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