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Objective: The constitutional experience with robot-assisted partial nephrectomy (RAPN) associates with better surgical outcomes. Then, surgeon’s generation may impact on surgical outcomes. We evaluated the perioperative outcomes of RAPN between first- and second-generation surgeons according to the surgeon’s experience.Methods: This study included 529 patients who underwent RAPN for renal cell carcinoma from January 2013 to November 2018. Four specific surgeons performed the surgery. The patients were divided into two groups according to the surgeon: first-generation and second-generation. To reflect the learning curve of RAPN, the surgical outcomes of each case (1-50, 51-100, 101-150) were evaluated between groups. Results: Although significant differences in patient and tumor characteristics were not observed between the two groups, there was a trend of a higher rate of high complexity tumors in the first-generation group than in the second-generation group, although not statistically significant. The second-generation group had a shorter operation time in cases 1-50 (169 min vs. 188 min, p = 0.0001), 51-100 (145 min vs. 169 min, p = 0.008), and 101-150 (142 min vs. 165 min, p = 0.009), than the first-generation group. Although shorter WIT and higher trifecta achievement were observed in the second-generation group compared to the first-generation group between 1 to 50 cases, the difference was not noted between 51-100 cases and 101-150 cases. Conclusion: Second-generation surgeons had better surgical outcomes than first-generation surgeons, especially during the early experience period, which might result from their assistant experience, sophisticated surgical procedures refined by the first-generation, and the first-generation surgeon’s introduction.

Background: To investigate subsequent renal function from the new baseline in patietns who underwent partial nephrectomy (PN) for renal tumors, and analyze factors associated with the renal functional change.Methods: This study included 466 patients who underwent PN for stage 1 kidney tumors and were regularly followed up for at least 5 years. The new baseline kidney function was defined as eGFR at 6 months after surgery. Kidney function was evaluated at every year for five years after surgery, and kidney function change was calculated as eGFR at 6 months after surgery-eGFR at each year after surgery/eGFR at 6 months after surgery × 100 (%). Factors associated with kidney functional change were evaluated with multivariate cox regression analysis.Results: The median age of patients was 60 years, and 76% of them were male. The median preoperative eGFR was 68 ml/min/1.73m2, and 35% and 14% of the patients had hyptertension and diabetes mellitus (DM), respectively. The new baseline eGFR was 61 ml/min/1.73m2. The mean kidney function change from the new baseline was -0.7% at one year, -1.1% at two years, -2.7% at three years, -3.8% at four years, and -5.4% at five years. Multivariate analysis showed that DM, preoperative lower eGFR and high complexity tumors were significantly associated with decreased kidney function from baseline to five years after surgery.Conclusions: Kidney function sequentialy decreased from the new baseline after PN. DM, lower preoperative eGFR and high complexity tumor were independent predictors for deterioration of eGFR from the new baseline to 5 years postoperatively.

Objectives To investigate the long-term follow-up outcomes of nivolumab monotherapy for previously treated metastatic renal cell carcinoma, using real-world data. Methods A total of 121 patients were treated with nivolumab monotherapy as subsequent therapy after the failure of prior tyrosine kinase inhibitor therapy between January 2013 and December 2021 at four affiliated institutions. To evaluate the outcome after 2 years or more, we selected patients in whom nivolumab therapy was started in December 2019 or earlier because data collection was performed until the end of December 2021. Results Seventy-four patients were evaluated. During the median follow-up period of 25.8 months, 62 (84%) and 40 (54%) patients had disease progression and died, respectively. Nivolumab was administered as second-line therapy in 43 patients (58%). The median progression-free survival and overall survival were 5.52 and 31.1 months, respectively, and objective response rate was 36%. There was no difference in progression-free survival or overall survival based on the treatment line of nivolumab (P = 0.915, P = 0.559). The magnitude of tumor response and development of immune-related adverse events were significantly associated with progression-free survival (P < 0.0001, P < 0.0001, respectively) and overall survival (P < 0.0001, P = 0.0002, respectively). Treatment-related adverse events developed in 38 patients (51%), including 33 (45%) who had immune-related adverse events. Steroid administration was needed in nine patients (12%). Conclusions The present real-world multi-institution study with long-term follow-up data demonstrates that nivolumab monotherapy is effective for previously treated metastatic renal cell carcinoma, prolonging survival, improving tumor response and has a manageable safety profile.