Jo-Lynn S Tan1, Niranjan Sathianathen1, Marcus Cumberbatch1, Prokar Dasgupta2, Alexandre Mottrie3, Ronney Abaza4, Koon Ho Rha5, Thyavihally B Yuvaraja6, Dipen J Parekh7, Umberto Capitanio8, Rajesh Ahlawat9, Sudhir Rawal10, Nicolò M Buffi11, Ananthakrishnan Sivaraman12, Kris K Maes13, Gagan Gautam14, Francesco Porpiglia15, Levent Turkeri16, Mahendra Bhandari17, Benjamin Challacombe18, James Roscoe Porter19, Craig R Rogers20, Daniel A Moon1. 1. Division of Cancer Surgery, Genitourinary Oncology, Peter MacCallum Cancer Centre, Vic., Australia. 2. DMRC Centre of Transplantation, King's College, London, UK. 3. Department of Urology, ORSI Academy, Melle, Belgium. 4. Department of Urology, Dublin Methodist Hospital, Dublin, OH, USA. 5. Department of Urology, Yonsei University Health System, Seoul, South Korea. 6. Department of Urology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India. 7. Department of Urology, University of Miami Health System, Miami, FL, USA. 8. Department of Urology, San Raffaele Hospital, Milan, Italy. 9. Department of Urology, Medanta The Medicity Hospital, New Delhi, India. 10. Department of Urology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India. 11. Department of Urology, Humanitas Research Hospital, Milan, Italy. 12. Department of Urology, Apollo Hospitals, Chennai, India. 13. Department of Urology, Centre for Robotic and Minimally Invasive Surgery, Hospital Da Luz, Luz Sáude, Portugal. 14. Department of Urology, Max Institute of Cancer Care, Max Hospital, New Delhi, India. 15. Department of Urology, San Luigi Gonzaga Hospital of Orbassano, Turin, Italy. 16. Department of Urology, Acıbadem Hospitals Group, Istanbul, Turkey. 17. Department of Urology, Vattikuti Foundation, Detroit, MI, USA. 18. Guys and St Thomas' Hospital, London, UK. 19. Swedish Medical Centre, Seattle, WA, USA. 20. Henry Ford Hospital, Detroit, MI, USA.
Abstract
OBJECTIVES: To assess and compare peri-operative outcomes of patients undergoing robot-assisted partial nephrectomy (RAPN) for imperative vs elective indications. PATIENT AND METHODS: We retrospectively reviewed a multinational database of 3802 adults who underwent RAPN for elective and imperative indications. Laparoscopic or open partial nephrectomy (PN) were excluded. Baseline data for age, gender, body mass index, American Society of Anaesthesiologists score and PADUA score were examined. Patients undergoing RAPN for an imperative indication were matched to those having surgery for an elective indication using propensity scores in a 1:3 ratio. Primary outcomes included organ ischaemic time, operating time, estimated blood loss (EBL), rate of blood transfusions, Clavien-Dindo complications, conversion to radical nephrectomy (RN) and positive surgical margin (PSM) status. RESULTS: After propensity-score matching for baseline variables, a total of 304 patients (76 imperative vs 228 elective indications) were included in the final analysis. No significant differences were found between groups for ischaemia time (19.9 vs 19.8 min; P = 0.94), operating time (186 vs 180 min; P = 0.55), EBL (217 vs 190 mL; P = 0.43), rate of blood transfusions (2.7% vs 3.7%; P = 0.51), or Clavien-Dindo complications (P = 0.31). A 38.6% (SD 47.9) decrease in Day-1 postoperative estimated glomerular filtration rate was observed in the imperative indication group and an 11.3% (SD 45.1) decrease was observed in the elective indication group (P < 0.005). There were no recorded cases of permanent or temporary dialysis. There were no conversions to RN in the imperative group, and seven conversions (5.6%) in the elective group (P = 0.69). PSMs were seen in 1.4% (1/76) of the imperative group and in 3.3% of the elective group (7/228; P = 0.69). CONCLUSION: We conclude that RAPN is feasible and safe for imperative indications and demonstrates similar outcomes to those achieved for elective indications.
OBJECTIVES: To assess and compare peri-operative outcomes of patients undergoing robot-assisted partial nephrectomy (RAPN) for imperative vs elective indications. PATIENT AND METHODS: We retrospectively reviewed a multinational database of 3802 adults who underwent RAPN for elective and imperative indications. Laparoscopic or open partial nephrectomy (PN) were excluded. Baseline data for age, gender, body mass index, American Society of Anaesthesiologists score and PADUA score were examined. Patients undergoing RAPN for an imperative indication were matched to those having surgery for an elective indication using propensity scores in a 1:3 ratio. Primary outcomes included organ ischaemic time, operating time, estimated blood loss (EBL), rate of blood transfusions, Clavien-Dindo complications, conversion to radical nephrectomy (RN) and positive surgical margin (PSM) status. RESULTS: After propensity-score matching for baseline variables, a total of 304 patients (76 imperative vs 228 elective indications) were included in the final analysis. No significant differences were found between groups for ischaemia time (19.9 vs 19.8 min; P = 0.94), operating time (186 vs 180 min; P = 0.55), EBL (217 vs 190 mL; P = 0.43), rate of blood transfusions (2.7% vs 3.7%; P = 0.51), or Clavien-Dindo complications (P = 0.31). A 38.6% (SD 47.9) decrease in Day-1 postoperative estimated glomerular filtration rate was observed in the imperative indication group and an 11.3% (SD 45.1) decrease was observed in the elective indication group (P < 0.005). There were no recorded cases of permanent or temporary dialysis. There were no conversions to RN in the imperative group, and seven conversions (5.6%) in the elective group (P = 0.69). PSMs were seen in 1.4% (1/76) of the imperative group and in 3.3% of the elective group (7/228; P = 0.69). CONCLUSION: We conclude that RAPN is feasible and safe for imperative indications and demonstrates similar outcomes to those achieved for elective indications.