Xiaozhi Zhao1, Qun Lu1, Riccardo Campi2, Changwei Ji1, Suhan Guo3, Guangxiang Liu1, Shiwei Zhang1, Xiaogong Li1, Weidong Gan1, Andrea Minervini2, Hongqian Guo4. 1. Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, People's Republic of China. 2. Department of Urology, Careggi Hospital, University of Florence, Florence, Italy. 3. School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China. 4. Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, People's Republic of China. Electronic address: dr.guohongqian@gmail.com.
Abstract
OBJECTIVE: To compare perioperative results and early oncological outcomes of endoscopic robot-assisted simple enucleation (ERASE) and laparoscopic simple enucleation (LSE) by using a propensity score-matched analysis. METHODS: We evaluated 383 patients who underwent transperitoneal ERASE or LSE for renal tumors from November 2012 to October 2016. Propensity score matching was performed on age, gender, body mass index, Eastern Cooperative Oncology Group score, tumor side and size, preoperative estimated GFR and PADUA score. RESULTS: In total, 278 and 105 patients underwent ERASE and LSE, respectively. The PADUA score was ≥10 for 61 (21.9%) and 13 (12.4%), respectively (P = .034). After matching, mean operative time and warm ischemic time were significantly lower with ERASE than LSE (171.9 vs 188.2 minutes; P = 0.016 and 20.9 vs 24.2 minutes; P = .001). The estimated mean blood loss was similar (167.7 vs 183.3 mL; P = .315). The conversion rate to open surgery or radical nephrectomy was similar with ERASE and LSE (1.0% vs 5.0%, P = .214) and the rate of intraoperative complications was lower (2.0% vs 8.9%, P = .030). The overall incidence of positive surgical margins was similar (P = .614). The median follow-up was less for ERASE than LSE patients (22 vs 38 months). Recurrence did not differ between the 2 groups: 2 ERASE cases (2.0%) versus 4 LSE cases (4.0%) (P = .679). CONCLUSION: ERASE is a safe and acceptable alternative to LSE. ERASE appears to confer shorter operative time, shorter warm ischemic time and lower rate of intraoperative complication.
OBJECTIVE: To compare perioperative results and early oncological outcomes of endoscopic robot-assisted simple enucleation (ERASE) and laparoscopic simple enucleation (LSE) by using a propensity score-matched analysis. METHODS: We evaluated 383 patients who underwent transperitoneal ERASE or LSE for renal tumors from November 2012 to October 2016. Propensity score matching was performed on age, gender, body mass index, Eastern Cooperative Oncology Group score, tumor side and size, preoperative estimated GFR and PADUA score. RESULTS: In total, 278 and 105 patients underwent ERASE and LSE, respectively. The PADUA score was ≥10 for 61 (21.9%) and 13 (12.4%), respectively (P = .034). After matching, mean operative time and warm ischemic time were significantly lower with ERASE than LSE (171.9 vs 188.2 minutes; P = 0.016 and 20.9 vs 24.2 minutes; P = .001). The estimated mean blood loss was similar (167.7 vs 183.3 mL; P = .315). The conversion rate to open surgery or radical nephrectomy was similar with ERASE and LSE (1.0% vs 5.0%, P = .214) and the rate of intraoperative complications was lower (2.0% vs 8.9%, P = .030). The overall incidence of positive surgical margins was similar (P = .614). The median follow-up was less for ERASE than LSE patients (22 vs 38 months). Recurrence did not differ between the 2 groups: 2 ERASE cases (2.0%) versus 4 LSE cases (4.0%) (P = .679). CONCLUSION: ERASE is a safe and acceptable alternative to LSE. ERASE appears to confer shorter operative time, shorter warm ischemic time and lower rate of intraoperative complication.
Authors: Marco Milone; Michele Manigrasso; Pietro Anoldo; Anna D'Amore; Ugo Elmore; Mariano Cesare Giglio; Gianluca Rompianesi; Sara Vertaldi; Roberto Ivan Troisi; Nader K Francis; Giovanni Domenico De Palma Journal: J Pers Med Date: 2022-02-18