Hugo Otaola-Arca1,2, Alfred Krebs1,2, Hugo Bermúdez1,2, Raúl Lyng1,2, Marcelo Orvieto1,2, Alberto Bustamante1,2, Conrado Stein1,2, Andrés Labra2,3, Marcela Schultz2,4, Mario I Fernández5,6. 1. Department of Urology, Clínica Alemana de Santiago, Santiago, Chile. 2. Faculty of Medicine, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile. 3. Department of Radiology, Clínica Alemana de Santiago, Santiago, Chile. 4. Department of Pathology, Clínica Alemana de Santiago, Santiago, Chile. 5. Department of Urology, Clínica Alemana de Santiago, Santiago, Chile. mfernandeza@alemana.cl. 6. Faculty of Medicine, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile. mfernandeza@alemana.cl.
Abstract
BACKGROUND: To evaluate long-term oncological and renal function outcomes in patients treated with robot-assisted partial nephrectomy (RAPN) for renal cell carcinoma (RCC). PATIENTS AND METHODS: Patients undergoing RAPN for clinically localized RCC between January 2014 and December 2019 at a tertiary robotic reference center were evaluated. Clinical course, pathologic characteristics, and long-term outcomes were obtained from our institutional review board-approved RCC database. RESULTS: A total of 234 patients were available for analysis. Median follow-up was 46 months (10.8-97.8 months), with 77 patients (32.9%) having at least 5-years of follow-up. Pathology revealed clear-cell RCC in 67.5% (n = 158). Among unfavorable factors, nuclear grades 3 or 4 were found in 67 (29.4%), lymphovascular invasion in 10 (4.3%), positive surgical margins in 22 (9.4%), necrosis in 21 (9%), and sarcomatoid pattern in 2 patients (0.9%). At 12 months, mean serum creatinine was 1.04 mg/dL and 12.9% of patients experienced upstaging in chronic kidney disease. Overall recurrence-free survival at 5-years was 97.8%. There were five local (2.1%) and two distant (0.9%) recurrences, none of them resulting in cancer-specific death. Median time to recurrence was 20 months (11-64 months). Warm ischemia time [hazard ratio (HR) = 1.14, p = 0.034] and sarcomatoid pattern (HR = 124.57, p = 0.001) were the only variables associated with local relapse. CONCLUSIONS: Data from this large cohort demonstrate that patients undergoing RAPN have a low incidence of local and distant relapse, resulting in excellent long-term survival while preserving stable renal function in most patients.
BACKGROUND: To evaluate long-term oncological and renal function outcomes in patients treated with robot-assisted partial nephrectomy (RAPN) for renal cell carcinoma (RCC). PATIENTS AND METHODS: Patients undergoing RAPN for clinically localized RCC between January 2014 and December 2019 at a tertiary robotic reference center were evaluated. Clinical course, pathologic characteristics, and long-term outcomes were obtained from our institutional review board-approved RCC database. RESULTS: A total of 234 patients were available for analysis. Median follow-up was 46 months (10.8-97.8 months), with 77 patients (32.9%) having at least 5-years of follow-up. Pathology revealed clear-cell RCC in 67.5% (n = 158). Among unfavorable factors, nuclear grades 3 or 4 were found in 67 (29.4%), lymphovascular invasion in 10 (4.3%), positive surgical margins in 22 (9.4%), necrosis in 21 (9%), and sarcomatoid pattern in 2 patients (0.9%). At 12 months, mean serum creatinine was 1.04 mg/dL and 12.9% of patients experienced upstaging in chronic kidney disease. Overall recurrence-free survival at 5-years was 97.8%. There were five local (2.1%) and two distant (0.9%) recurrences, none of them resulting in cancer-specific death. Median time to recurrence was 20 months (11-64 months). Warm ischemia time [hazard ratio (HR) = 1.14, p = 0.034] and sarcomatoid pattern (HR = 124.57, p = 0.001) were the only variables associated with local relapse. CONCLUSIONS: Data from this large cohort demonstrate that patients undergoing RAPN have a low incidence of local and distant relapse, resulting in excellent long-term survival while preserving stable renal function in most patients.
Authors: A Mari; A Antonelli; R Bertolo; G Bianchi; M Borghesi; V Ficarra; C Fiori; M Furlan; S Giancane; N Longo; V Mirone; G Morgia; F Porpiglia; B Rovereto; R Schiavina; S Serni; C Simeone; A Volpe; M Carini; A Minervini Journal: Eur J Surg Oncol Date: 2016-11-05 Impact factor: 4.424
Authors: Andrew S Levey; Josef Coresh; Ethan Balk; Annamaria T Kausz; Adeera Levin; Michael W Steffes; Ronald J Hogg; Ronald D Perrone; Joseph Lau; Garabed Eknoyan Journal: Ann Intern Med Date: 2003-07-15 Impact factor: 25.391
Authors: Francesco Porpiglia; Andrea Mari; Riccardo Bertolo; Alessandro Antonelli; Giampaolo Bianchi; Francesco Fidanza; Cristian Fiori; Maria Furlan; Giuseppe Morgia; Giacomo Novara; Bernardo Rocco; Bruno Rovereto; Sergio Serni; Claudio Simeone; Marco Carini; Andrea Minervini Journal: Urology Date: 2015-12-29 Impact factor: 2.649