Riccardo Bertolo1, Riccardo Autorino2, Giuseppe Simone3, Ithaar Derweesh4, Juan D Garisto5, Andrea Minervini6, Daniel Eun7, Sisto Perdona8, James Porter9, Koon Ho Rha10, Alexander Mottrie11, Wesley M White12, Luigi Schips13, Bo Yang14, Kenneth Jacobsohn15, Robert G Uzzo16, Ben Challacombe17, Matteo Ferro18, Jay Sulek19, Umberto Capitanio20, Uzoma A Anele21, Gabriele Tuderti3, Manuela Costantini3, Stephen Ryan4, Ahmet Bindayi4, Andrea Mari6, Marco Carini6, Aryeh Keehn7, Giuseppe Quarto8, Michael Liao9, Kidon Chang22, Alessandro Larcher23, Geert De Naeyer11, Ottavio De Cobelli18, Francesco Berardinelli13, Chao Zhang14, Peter Langenstroer15, Alexander Kutikov16, David Chen16, Nicolo De Luyk17, Chandru P Sundaram19, Francesco Montorsi20, Robert J Stein5, Georges Pascal Haber5, Lance J Hampton21, Prokar Dasgupta17, Michele Gallucci3, Jihad Kaouk5, Francesco Porpiglia24. 1. Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy; Department of Urology, Cleveland Clinic, Cleveland, OH, USA. 2. Division of Urology, Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA. Electronic address: ricautor@gmail.com. 3. Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy. 4. Department of Urology, UCSD Health System, La Jolla, CA, USA. 5. Department of Urology, Cleveland Clinic, Cleveland, OH, USA. 6. Department of Urology, University of Florence, Careggi Hospital, Firenze, Italy. 7. Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA. 8. Division of Urology, IRCCS Fondazione G.Pascale, Naples, Italy. 9. Swedish Urology Group, Seattle, WA, USA. 10. Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea. 11. Department of Urology, OLV Hospital, Aalst, Belgium. 12. Department of Urology, University of Tennessee Medical Center, Knoxville, TN, USA. 13. Department of Urology, Annunziata Hospital, G. D'Annunzio University, Chieti, Italy. 14. Department of Urology, Changhai Hospital, Shanghai, China. 15. Department of Urology, Medical College Wisconsin, Milwaukee, WA, USA. 16. Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA. 17. MRC Centre for Transplantation, NIHR Biomedical Research Centre, Guy's Hospital, King's College, London, UK. 18. Department of Urology, IEO, Milan, Italy. 19. Department of Urology, Indiana University, Indianapolis, IN, USA. 20. Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy. 21. Division of Urology, Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA. 22. Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea. 23. Department of Urology, OLV Hospital, Aalst, Belgium; Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy. 24. Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy.
Abstract
BACKGROUND: While partial nephrectomy (PN) represents the standard surgical management for cT1 renal masses, its role for cT2 tumors is controversial. Robot-assisted PN (RAPN) is being increasingly implemented worldwide. OBJECTIVE: To analyze perioperative, functional, and oncological outcomes of RAPN for cT2 tumors. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of a large multicenter, multinational dataset of patients with nonmetastatic cT2 masses treated with robotic surgery (ROSULA: RObotic SUrgery for LArge renal mass). INTERVENTION: Robotic-assisted PN. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Patients' demographics, lesion characteristics, perioperative variables, renal functional data, pathology, and oncological data were analyzed. Univariable and multivariable regression analyses assessed the relationships with the risk of intra-/postoperative complications, recurrence, and survival. RESULTS AND LIMITATIONS: A total of 298 patients were analyzed. Median tumor size was 7.6 (7-8.5) cm. Median RENAL score was 9 (8-10). Median ischemia time was 25 (20-32) min. Median estimated blood loss was 150 (100-300) ml. Sixteen patients had intraoperative complications (5.4%), whereas 66 (22%) had postoperative complications (5% were Clavien grade ≥3). Multivariable analysis revealed that a lower RENAL score (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.21-0.65, p=0.02) and pathological pT2 stage (OR 0.51, 95% CI 0.12-0.86, p=0.001) were protective against postoperative complications. A total of 243 lesions (82%) were malignant. Twenty patients (8%) had positive surgical margins. Ten deaths and 25 recurrences/metastases occurred at a median follow-up of 12 (5-35) mo. At univariable analysis, higher pT stage was predictive of a likelihood of recurrences/metastases (p=0.048). While there was a significant deterioration of renal function at discharge, this remained stable over time at 1-yr follow-up. The main limitation of this study is its retrospective design. CONCLUSIONS: RAPN in the setting of select cT2 renal masses can safely be performed with acceptable outcomes. Further studies are warranted to corroborate our findings and to better define the role of robotic nephron sparing for this challenging indication. PATIENT SUMMARY: This report shows that robotic surgery can be used for safe removal of a large renal tumor in a minimally invasive fashion, maximizing preservation of renal function, and without compromising cancer control. Published by Elsevier B.V.
BACKGROUND: While partial nephrectomy (PN) represents the standard surgical management for cT1 renal masses, its role for cT2tumors is controversial. Robot-assisted PN (RAPN) is being increasingly implemented worldwide. OBJECTIVE: To analyze perioperative, functional, and oncological outcomes of RAPN for cT2tumors. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of a large multicenter, multinational dataset of patients with nonmetastatic cT2 masses treated with robotic surgery (ROSULA: RObotic SUrgery for LArge renal mass). INTERVENTION: Robotic-assisted PN. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Patients' demographics, lesion characteristics, perioperative variables, renal functional data, pathology, and oncological data were analyzed. Univariable and multivariable regression analyses assessed the relationships with the risk of intra-/postoperative complications, recurrence, and survival. RESULTS AND LIMITATIONS: A total of 298 patients were analyzed. Median tumor size was 7.6 (7-8.5) cm. Median RENAL score was 9 (8-10). Median ischemia time was 25 (20-32) min. Median estimated blood loss was 150 (100-300) ml. Sixteen patients had intraoperative complications (5.4%), whereas 66 (22%) had postoperative complications (5% were Clavien grade ≥3). Multivariable analysis revealed that a lower RENAL score (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.21-0.65, p=0.02) and pathological pT2 stage (OR 0.51, 95% CI 0.12-0.86, p=0.001) were protective against postoperative complications. A total of 243 lesions (82%) were malignant. Twenty patients (8%) had positive surgical margins. Ten deaths and 25 recurrences/metastases occurred at a median follow-up of 12 (5-35) mo. At univariable analysis, higher pT stage was predictive of a likelihood of recurrences/metastases (p=0.048). While there was a significant deterioration of renal function at discharge, this remained stable over time at 1-yr follow-up. The main limitation of this study is its retrospective design. CONCLUSIONS: RAPN in the setting of select cT2 renal masses can safely be performed with acceptable outcomes. Further studies are warranted to corroborate our findings and to better define the role of robotic nephron sparing for this challenging indication. PATIENT SUMMARY: This report shows that robotic surgery can be used for safe removal of a large renal tumor in a minimally invasive fashion, maximizing preservation of renal function, and without compromising cancer control. Published by Elsevier B.V.
Authors: Clément Michiels; Zine-Eddine Khene; Thomas Prudhomme; Astrid Boulenger de Hauteclocque; François H Cornelis; Mélanie Percot; Hélène Simeon; Laure Dupitout; Henri Bensadoun; Grégoire Capon; Eric Alezra; Vincent Estrade; Franck Bladou; Grégoire Robert; Jean-Marie Ferriere; Nicolas Grenier; Nicolas Doumerc; Karim Bensalah; Jean-Christophe Bernhard Journal: World J Urol Date: 2021-04-02 Impact factor: 4.226
Authors: Arnav Srivastava; Hiren V Patel; Sinae Kim; Brian Shinder; Joshua Sterling; Alexandra L Tabakin; Charles F Polotti; Biren Saraiya; Tina Mayer; Isaac Y Kim; Saum Ghodoussipour; Hiten D Patel; Thomas L Jang; Eric A Singer Journal: Urol Oncol Date: 2020-10-20 Impact factor: 3.498