Francesco Porpiglia1, Andrea Mari2, Riccardo Bertolo1, Alessandro Antonelli3, Giampaolo Bianchi4, Francesco Fidanza4, Cristian Fiori1, Maria Furlan3, Giuseppe Morgia5, Giacomo Novara6, Bernardo Rocco7, Bruno Rovereto8, Sergio Serni2, Claudio Simeone3, Marco Carini2, Andrea Minervini9. 1. Department of Urology, University of Turin, Ospedale San Luigi Gonzaga, Orbassano, Italy. 2. Department of Urology, Careggi Hospital, University of Florence, Florence, Italy. 3. Department of Urology, Azienda AO Spedali Civili di Brescia, Italy. 4. Policlinico di Modena, Department of Urology, University of Modena, Italy. 5. Luna Foundation. 6. Department of Urology, University of Padua, Italy. 7. Department of Urology, University of Padua, I.R.C.C.S. Foundation Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy. 8. I.R.C.C.S. Policlinico San Matteo-Department of Urology, Pavia, Italy. 9. Department of Urology, Careggi Hospital, University of Florence, Florence, Italy. Electronic address: andreamine@libero.it.
Abstract
OBJECTIVE: To evaluate perioperative results of open (OPN), laparoscopic (LPN), and robot-assisted partial nephrectomies (RAPN) and to identify predictive factors of Trifecta achievement for clinical T1b renal tumors in a multicenter prospective dataset. METHODS: Data of 285 patients who had OPN (133), LPN (57), or RAPN (95) for cT1b renal tumors were extracted from the RECORd Project. High-volume centers were defined as ≥50 overall cases of partial nephrectomy per year. Trifecta was defined as simultaneous absence of perioperative complications, negative surgical margins, and ischemia time <25 minutes. RESULTS: The 3 groups had comparable body mass index, preoperative hemoglobin, creatinine and estimated glomerular filtration rate, tumor clinical diameter, and growth pattern. LPN and RAPN were more frequently exclusive of high-volume centers. RAPN showed significantly lower median estimated blood loss compared with OPN and LPN. Trifecta was achieved in 62.4%, 63.2%, and 69.5% of OPN, LPN, and RAPN (P = NS) cases. Median warm ischemia time (WIT) was significantly shorter during OPN than during LPN and RAPN. RAPN had significantly shorter WIT compared with LPN. RAPN was significantly less morbid than OPN regarding intraoperative and postoperative complications. LPN (1.9%) and RAPN (2.5%) showed a lower rate of positive margins compared with OPN (6.8%) (P = NS). At multivariable analysis, exophytic tumor growth pattern, estimated blood loss, and high-volume centers were significant predictive factors for Trifecta achievement. CONCLUSION: Clinically, T1b renal tumors suitable for NSS can be safely treated by LPN or RAPN in high-volume centers. RAPN allows for significantly lower WIT and estimated blood loss with higher rate of Trifecta achievement compared with LPN.
OBJECTIVE: To evaluate perioperative results of open (OPN), laparoscopic (LPN), and robot-assisted partial nephrectomies (RAPN) and to identify predictive factors of Trifecta achievement for clinical T1b renal tumors in a multicenter prospective dataset. METHODS: Data of 285 patients who had OPN (133), LPN (57), or RAPN (95) for cT1b renal tumors were extracted from the RECORd Project. High-volume centers were defined as ≥50 overall cases of partial nephrectomy per year. Trifecta was defined as simultaneous absence of perioperative complications, negative surgical margins, and ischemia time <25 minutes. RESULTS: The 3 groups had comparable body mass index, preoperative hemoglobin, creatinine and estimated glomerular filtration rate, tumor clinical diameter, and growth pattern. LPN and RAPN were more frequently exclusive of high-volume centers. RAPN showed significantly lower median estimated blood loss compared with OPN and LPN. Trifecta was achieved in 62.4%, 63.2%, and 69.5% of OPN, LPN, and RAPN (P = NS) cases. Median warm ischemia time (WIT) was significantly shorter during OPN than during LPN and RAPN. RAPN had significantly shorter WIT compared with LPN. RAPN was significantly less morbid than OPN regarding intraoperative and postoperative complications. LPN (1.9%) and RAPN (2.5%) showed a lower rate of positive margins compared with OPN (6.8%) (P = NS). At multivariable analysis, exophytic tumor growth pattern, estimated blood loss, and high-volume centers were significant predictive factors for Trifecta achievement. CONCLUSION: Clinically, T1b renal tumors suitable for NSS can be safely treated by LPN or RAPN in high-volume centers. RAPN allows for significantly lower WIT and estimated blood loss with higher rate of Trifecta achievement compared with LPN.
Authors: Abimbola Ayangbesan; David M Golombos; Ron Golan; Padraic O'Malley; Patrick Lewicki; Xian Wu; Douglas S Scherr Journal: J Endourol Date: 2019-01 Impact factor: 2.942
Authors: Hugo Otaola-Arca; Alfred Krebs; Hugo Bermúdez; Raúl Lyng; Marcelo Orvieto; Alberto Bustamante; Conrado Stein; Andrés Labra; Marcela Schultz; Mario I Fernández Journal: Ann Surg Oncol Date: 2022-01-06 Impact factor: 5.344