Junya Furukawa1,2, Hiroomi Kanayama3,4, Haruhito Azuma3,5, Keiji Inoue3,6, Yasuyuki Kobayashi3,7, Akira Kashiwagi3,8, Takehiko Segawa3,9, Yoshihito Takahashi3,10, Shigeo Horie3,11, Osamu Ogawa3,12, Atsushi Takenaka3,13, Ryoichi Shiroki3,14, Kazunari Tanabe3,15, Masato Fujisawa16,3. 1. Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan. jfuru@med.kobe-u.ac.jp. 2. Japanese Society of Endourology, Robotic Partial Nephrectomy Observational Study Group, Tokyo, Japan. jfuru@med.kobe-u.ac.jp. 3. Japanese Society of Endourology, Robotic Partial Nephrectomy Observational Study Group, Tokyo, Japan. 4. Department of Urology, Institute of Biochemical Sciences, Tokushima University, Graduate School, Tokushima, Japan. 5. Department of Urology, Osaka Medical College, Takatsuki, Japan. 6. Department of Urology, Kochi Medical School, Kochi, Japan. 7. Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. 8. Department of Urology, Teine Keijinkai Hospital, Sapporo, Japan. 9. Department of Urology, Kyoto City Hospital, Kyoto, Japan. 10. Department of Urology, Gifu Prefectural General Medical Center, Gifu, Japan. 11. Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan. 12. Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan. 13. Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan. 14. Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan. 15. Department of Urology, Tokyo Women's Medical University, Tokyo, Japan. 16. Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.
Abstract
OBJECTIVE: The objective of this study was to evaluate the early surgical outcomes of robot-assisted partial nephrectomy (RAPN) for small renal masses in a large Japanese multicenter series. METHODS: A total of 804 consecutive cases of RAPN were examined at 42 institutes between 2011 and 2016. Medical records for clinical, pathological characteristics and perioperative outcomes were retrospectively reviewed. Univariable and multivariable analyses were performed to determine factors predicting Trifecta achievement. RESULTS: The median tumor size was 2.6 cm. The median RENAL score was 7. The median warm ischemia time was 21 min. The median estimated blood loss was 30 mL. Eight patients (1.0%) were converted to radical nephrectomy. The overall and Clavien-Dindo grade ≥ 3 complication rates were 13.0% and 5.8%, respectively. Pathologically, 91.4% of tumors were malignant and the positive surgical margin (PSM) rate was 1.1%. During the median 27.1-month observation period, the recurrence rate was 1.6%. Postoperative preservation rates of eGFR at 1, 6, 12 and 24 months were 90.3, 89.8, 89.4 and 89.2%, respectively. Trifecta was achieved in 62.1%. Multivariable analysis demonstrated that tumor diameter, estimated blood loss and hilar location of the tumor were significant negative factors predicting Trifecta achievement. The rate of Trifecta achievement for T1b tumors and hilar tumors was significantly lower (48.4% and 50.0%, respectively). CONCLUSIONS: RAPN was safely performed with acceptable oncological and functional outcomes, but the rate of Trifecta accomplishment for T1b or hilar tumors was significantly lower than that for T1a or non-hilar tumors, respectively.
OBJECTIVE: The objective of this study was to evaluate the early surgical outcomes of robot-assisted partial nephrectomy (RAPN) for small renal masses in a large Japanese multicenter series. METHODS: A total of 804 consecutive cases of RAPN were examined at 42 institutes between 2011 and 2016. Medical records for clinical, pathological characteristics and perioperative outcomes were retrospectively reviewed. Univariable and multivariable analyses were performed to determine factors predicting Trifecta achievement. RESULTS: The median tumor size was 2.6 cm. The median RENAL score was 7. The median warm ischemia time was 21 min. The median estimated blood loss was 30 mL. Eight patients (1.0%) were converted to radical nephrectomy. The overall and Clavien-Dindo grade ≥ 3 complication rates were 13.0% and 5.8%, respectively. Pathologically, 91.4% of tumors were malignant and the positive surgical margin (PSM) rate was 1.1%. During the median 27.1-month observation period, the recurrence rate was 1.6%. Postoperative preservation rates of eGFR at 1, 6, 12 and 24 months were 90.3, 89.8, 89.4 and 89.2%, respectively. Trifecta was achieved in 62.1%. Multivariable analysis demonstrated that tumor diameter, estimated blood loss and hilar location of the tumor were significant negative factors predicting Trifecta achievement. The rate of Trifecta achievement for T1b tumors and hilar tumors was significantly lower (48.4% and 50.0%, respectively). CONCLUSIONS: RAPN was safely performed with acceptable oncological and functional outcomes, but the rate of Trifecta accomplishment for T1b or hilar tumors was significantly lower than that for T1a or non-hilar tumors, respectively.
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