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Comparison of retroperitoneal and transperitoneal robotic partial nephrectomy for Pentafecta perioperative and renal functional outcomes

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A Letter to the Editor to this article was published on 04 November 2017

Abstract

Background

We compared quality outcomes between transperitoneal (TRPN) and retroperitoneal robotic partial nephrectomy (RRPN).

Methods

Two-center retrospective analysis of TRPN and RRPN from 10/2009 to 10/2015. Perioperative/renal function outcomes were analyzed. Primary endpoint was Pentafecta, a composite measure of quality [negative margin, no 30-day complication, ischemia time ≤25 min, return of glomerular filtration rate (eGFR) to >90% from baseline at last follow-up, and no chronic kidney disease upstaging]. Multivariable analysis (MVA) for factors associated with lack of optimal outcome was performed.

Results

404 patients (TRPN 263, RRPN 141) were analyzed. Comparing TRPN vs. RRPN, mean tumor size (3.1 vs. 2.9 cm, p = 0.122) and RENAL score (7.4 vs. 7.2, p = 0.503) were similar. Most TRPN were anterior (65.0%) and most RRPN posterior (65.3%, p < 0.001). Operative time (p = 0.001) was less for RRPN. No significant differences between TRPN vs. RRPN were noted for ischemia time (23.1 vs. 22.8 min, p = 0.313), blood loss (p = 0.772), positive margins (p = 0.590), complications (p = 0.537), length of stay (p = 0.296), ΔeGFR (p = 0.246), eGFR recovery to >90% (55.9 vs. 57.4%, p = 0.833), and lack of CKD upstaging (84.0 vs. 87.2%, p = 0.464). Pentafecta rates were not significantly different (TRPN 33.9 vs. RRPN 43.3%, p = 0.526). MVA revealed increasing RENAL score (OR 1.5, p < 0.001) and decreasing baseline eGFR (OR 2.4, p = 0.017) as predictive for lack of Pentafecta.

Conclusions

TRPN and RRPN have similar quality outcomes, though RRPN may offer modest benefit for operative time and have utility in posterior tumors. Association of increasing RENAL score and decreased baseline eGFR with lack of Pentafecta suggests dominant role of non-modifiable factors.

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Authors and Affiliations

  1. Department of Urology, Naval Medical Center San Diego, San Diego, CA, USA

    Sean P. Stroup, Michael T. Marshall & James O. L’Esperance

  2. Department of Urology, UC San Diego Health System, La Jolla, CA, USA

    Sean P. Stroup, Zachary A. Hamilton, Hak J. Lee, Sean W. Berquist, Abd-elrahman S. Hassan, Alp T. Beksac, Charles A. Field, Aaron Bloch, Fang Wan, Michelle L. McDonald, Nishant D. Patel & Ithaar H. Derweesh

  3. Department of Urology, Moores UCSD Cancer Center, 3855 Health Sciences Drive, Mail Code: 7897, La Jolla, CA, 92093-7897, USA

    Ithaar H. Derweesh

Authors
  1. Sean P. Stroup
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  2. Zachary A. Hamilton
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  3. Michael T. Marshall
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  4. Hak J. Lee
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  5. Sean W. Berquist
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  6. Abd-elrahman S. Hassan
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  7. Alp T. Beksac
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  8. Charles A. Field
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  9. Aaron Bloch
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  10. Fang Wan
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  11. Michelle L. McDonald
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  12. Nishant D. Patel
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  13. James O. L’Esperance
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  14. Ithaar H. Derweesh
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Contributions

SPS: project development, manuscript writing/editing. ZAH: data collection, data analysis, manuscript writing/editing. MTM: data collection, data analysis. HJL: data collection, data management. SWB: data collection, data management, data analysis. ASH: data collection, data management, data analysis. ATB: data collection, manuscript writing. CAF: data collection, data management. AB: data collection, data analysis. MLM: protocol development, data analysis, manuscript writing. NDP: protocol development, data collection, data management. JOL: protocol development, manuscript editing. IHD: protocol/project development, manuscript writing/editing.

Corresponding author

Correspondence to Ithaar H. Derweesh.

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Conflict of interest

None of the authors have any conflict of interest to declare.

Ethical standards

Ethical standards have been met and this study is IRB approved at both institutions.

Funding

Stephen Weissman Kidney Cancer Research Fund.

Disclosure

The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.

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Stroup, S.P., Hamilton, Z.A., Marshall, M.T. et al. Comparison of retroperitoneal and transperitoneal robotic partial nephrectomy for Pentafecta perioperative and renal functional outcomes. World J Urol 35, 1721–1728 (2017). https://doi.org/10.1007/s00345-017-2062-0

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  • DOI: https://doi.org/10.1007/s00345-017-2062-0

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