Benjamin Pradere1, Benoit Peyronnet2, Gauthier Delporte3, Quentin Manach4, Zine-Eddine Khene2, Morgan Moulin5, Mathieu Roumiguié6, Jérome Rizk3, Nicolas Brichart7, Jean-Baptiste Beauval6, Luc Cormier5, Axel Bex8, Morgan Rouprêt4, Franck Bruyère9, Karim Bensalah2. 1. Department of Urology, Centre Hospitalier Universitaire Tours, Tours, France. Electronic address: benjaminpradere@gmail.com. 2. Department of Urology, Centre Hospitalier Universitaire Rennes, Rennes, France. 3. Department of Urology, Centre Hospitalier Régional Universitaire Lille, Lille, France. 4. Department of Urology, Hôpital Pitié-Salpetrière, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France. 5. Department of Urology, Centre Hospitalier Universitaire Dijon, Dijon, France. 6. Department of Urology, Centre Hospitalier Universitaire Toulouse, Toulouse, France. 7. Department of Urology, Centre Hospitalier Orléans, Orléans, France. 8. Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands. 9. Department of Urology, Centre Hospitalier Universitaire Tours, Tours, France.
Abstract
PURPOSE: Our objective was to assess the prevalence of intraoperative cyst rupture and its impact on oncologic outcomes. MATERIALS AND METHODS: All patients who underwent partial nephrectomy for a cystic renal mass via an open or robot-assisted approach at a total of 8 academic institutions were included in this retrospective study. All operative reports were carefully reviewed and any description of cyst rupture, cyst effraction or local spillage intraoperatively was recorded as cyst rupture. Multivariate logistic regression analysis was done to assess the variables associated with cyst rupture. Recurrence-free, cancer specific and overall survival was estimated by the Kaplan-Meier method and compared with the log rank test. RESULTS: Overall 268 patients were included in study. There were 50 intraoperative cyst ruptures (18.7%) in the whole cohort. No preoperative parameter was significantly associated with a risk of intraoperative cyst rupture on univariate or multivariate analysis. Of the cystic renal masses 75% were malignant on the final pathology report. At a median followup of 32 months 5 patients (2.5%) had local recurrence while progression to metastasis was observed in 2%. There were no peritoneal carcinomatosis nor port site metastasis. There was also no local or metastatic recurrence in the subgroup with intraoperative cyst rupture. Estimated recurrence-free survival did not differ significantly between patients with vs without intraoperative cyst rupture at 100% vs 92.7% at 5 years (p = 0.20). CONCLUSIONS: Intraoperative cyst rupture during partial nephrectomy is a relatively common occurrence but with few oncologic implications.
PURPOSE: Our objective was to assess the prevalence of intraoperative cyst rupture and its impact on oncologic outcomes. MATERIALS AND METHODS: All patients who underwent partial nephrectomy for a cystic renal mass via an open or robot-assisted approach at a total of 8 academic institutions were included in this retrospective study. All operative reports were carefully reviewed and any description of cyst rupture, cyst effraction or local spillage intraoperatively was recorded as cyst rupture. Multivariate logistic regression analysis was done to assess the variables associated with cyst rupture. Recurrence-free, cancer specific and overall survival was estimated by the Kaplan-Meier method and compared with the log rank test. RESULTS: Overall 268 patients were included in study. There were 50 intraoperative cyst ruptures (18.7%) in the whole cohort. No preoperative parameter was significantly associated with a risk of intraoperative cyst rupture on univariate or multivariate analysis. Of the cystic renal masses 75% were malignant on the final pathology report. At a median followup of 32 months 5 patients (2.5%) had local recurrence while progression to metastasis was observed in 2%. There were no peritoneal carcinomatosis nor port site metastasis. There was also no local or metastatic recurrence in the subgroup with intraoperative cyst rupture. Estimated recurrence-free survival did not differ significantly between patients with vs without intraoperative cyst rupture at 100% vs 92.7% at 5 years (p = 0.20). CONCLUSIONS:Intraoperative cyst rupture during partial nephrectomy is a relatively common occurrence but with few oncologic implications.