Comparison of 1800 Robotic and Open Partial Nephrectomies for Renal Tumors

Peyronnet, B.; Seisen, Thomas; Oger, Emmanuel; Vaessen, Christophe; Grassano, Y.; Benoit, T.; Carrouget, J.; Pradère, Benjamin; Khene, Z.; Giwerc, A.; Mathiéu, Romain; Beauval, Jean-Baptiste; Nouhaud, François-Xavier; Bigot, Pierre; Doumerc, N.; Bernhard, Jean-Christophe; Méjean, Arnaud; Patard, Jean‐Jacques; Shariat, Shahrokh F.; Rouprêt, Morgan; Bensalah, Karim

doi:10.1245/s10434-016-5411-0

Cited by 146 publications

(99 citation statements)

References 28 publications

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“…The incidence of PA after PN found in the present study (1.2%) was consistent with the rates reported in the largest recent studies in the literature, ranging from 1% to 5% . In addition, these previous studies reported the rate of symptomatic PA, while we reported the incidence of asymptomatic PA.…”

Section: Discussionsupporting

confidence: 92%

“…The use of partial nephrectomy (PN) for the treatment of RCC has dramatically increased over the past decade, especially for small renal tumours, but also more recently for complex lesions . Haemorrhagic complications are a major concern after PN, and have been reported in 5–10% of patients . The postoperative bleeding risk is mostly related to the presence of pseudoaneurysm (PA), typically occurring within the first 14 days after PN .…”

Section: Introductionmentioning

confidence: 99%

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Is postoperative Doppler ultrasonography useful for the early detection of asymptomatic pseudoaneurysm and prevention of haemorrhagic complications after partial nephrectomy?

et al. 2018

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ObjectiveTo assess the clinical utility of systematic Doppler ultrasonography (DUS) after robot-assisted partial nephrectomy (PN) for the detection of renal artery pseudoaneurysm (PA) and to allow pre-emptive arterial embolization to reduce the postoperative bleeding risk. Materials and MethodsA retrospective study was conducted including all consecutive patients treated with robot-assisted PN for renal tumours between 2015 and 2017. Every patient underwent renal DUS in the early postoperative period. The presence of PA, arteriovenous malformation or collection on the DUS, as well as the incidence of haemorrhagic complications and need for transfusion/embolization were assessed. ResultsEighty-three patients were included, with a median (range) age of 58 (19-80) years. The median (range) follow-up was 5 (1-30) months. The mean (AESD) tumour size was 31 (AE13.1) mm, the median (range) RENAL nephrometry score was 6 (4-11), and the mean (AESD) warm ischaemia time was 22 (AE7) min. A haemostatic agent was used in 12 patients (14.5%). No patient encountered haemorrhagic complications postoperatively, and no patient required transfusion. The median (interquartile range) time to DUS postoperatively was 7 (6-8) days. DUS revealed one asymptomatic PA (1.2%), which was treated with pre-emptive embolization. This was the only patient who encountered a Clavien grade III complication, while 20 patients (24%) had a complication grade I/II. ConclusionsNo haemorrhagic complications occurred in the present study population, although one asymptomatic PA was found. It was diagnosed early with DUS, allowing pre-emptive management with embolization. These results suggest the potential clinical utility of early postoperative DUS in order to screen for PA to reduce the risk of post-PN haemorrhagic complications.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Is postoperative Doppler ultrasonography useful for the early detection of asymptomatic pseudoaneurysm and prevention of haemorrhagic complications after partial nephrectomy?

et al. 2018

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“…Thirty‐four eligible studies included 60 808 patients who underwent PN, of whom 19 638 underwent RaPN with mean age 58.9 years and 41 170 underwent OPN with mean age 58.5 years. Table presents the baseline patient demographics of all enrolled studies.…”

Section: Resultsmentioning

confidence: 99%

Open versus robotic partial nephrectomy: Systematic review and meta‐analysis of contemporary studies

Tsai

Tseng²,

Sherer

et al. 2018

Robotics Computer Surgery

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Objectives To compare perioperative outcomes of robotic‐assisted partial nephrectomy (RaPN) with open partial nephrectomy (OPN). Methods Systematically search through PubMed, Embase, ClinicalKey, Cochrane Library, ProQuest, ScienceDirect, Web of Science, and http://ClinicalTrials.gov for eligible studies was performed to April 11, 2018. A meta‐analysis was conducted for studies comparing RaPN and OPN. Confounding variables were assessed by meta‐regression or subgroup analysis. Results This study included 34 studies with 60 808 patients. Meta‐analysis revealed less blood loss, less transfusion, longer operative time, less postoperative complications, lower readmission rate, shorter length of stay, and less estimated glomerular filtration rate (eGFR) decline in RaPN groups. The superiority of RaPN in blood loss was attenuated with highly complex renal masses. The superiority of RaPN in intraoperative complications was strengthened with renal hilar control. The advantage of RaPN in surgical margin was increased in patient with body mass index (BMI) < 28. Conclusions Compared with OPN, RaPN provided lower morbidities and better renal function preservation.

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“…3,[11][12][13] This present report confirms these prior reports. 14 Peyronnet et al report in this issue of Annals of Surgical Oncology that RPN is associated with favorable perioperative outcomes when compared with OPN. Data were collected from 1800 patients in this retrospective multicenter study, including 937 RPN and 863 OPN.…”

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Comparison of 1800 Robotic and Open Partial Nephrectomies for Renal Tumors

Bezinque

Lane

2016

Ann Surg Oncol

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Partial nephrectomy (PN) is the reference standard for renal tumors that are amenable to a kidney-sparing approach. With oncologic outcomes superior to thermal ablation and renal functional outcomes superior to radical nephrectomy, the number of situations in which PN is employed is growing.1,2 The outcomes of PN vary greatly with surgeon experience, variations in technique, and tumor complexity. Several techniques have been developed and modified during the past 30 years or more, with contemporary discussions addressing optimization of the oncologic, renal functional, and postoperative outcomes of PN. 3During the late 1990s, minimally invasive PN was pioneered using pure laparoscopic techniques. 4,5 In the initial single-center series reported, laparoscopic PN (LPN) was found to be feasible and with acceptable morbidity when performed by master laparoscopic surgeons who were building upon the experience of prior experts' open surgical techniques. [4][5][6] Comparison of results from these initial series of LPN with OPN performed well after the initial learning curve for this procedure revealed both advantages and disadvantages for LPN despite the somewhat imbalanced comparison.7 LPN offered the advantages of decreased operative time (median 3. In these 1800 patients, the disadvantages of LPN were longer warm ischemia time (median 31 vs. 20 min; RR: 1.69 (95 % CI: 1.62-1.77), p \ 0.0001), more urologic complications (9.2 vs. 5.0 %; odds ratio [OR]: 2.14 (95 % CI: 1.39-3.31), p = 0.0006), and more nonurologic complications (15.7 vs. 14.3 %; OR: 1.53 (95 % CI: 1.12-2.10), p = 0.0077). The major concerns for LPN were the higher observed rate of postoperative hemorrhage and urine leak that was accentuated by the larger tumors and less fit patients in the cohort undergoing OPN. 6 With further refinements in technique, the results of minimally invasive PN have improved substantially during 15? years of refinement. 3,8 With LPN, and more recently with robotic PN (RPN), ischemia times and complications have decreased substantially.3,9 When directly comparing similar cohorts undergoing LPN or RPN by the same surgeons, RPN was associated with shorter hospital stays (2.4 vs. 2.7 days), shorter ischemic intervals (19.7 vs. 28.4 min), and lower complication rates (8.6 vs. 10.2 %) in a multi-institutional study.10 Meta-analysis of multiple retrospective studies indicated that LPN and RPN provided comparable hospital stay and complication rates, with an advantage of shorter ischemia time for RPN even with greater tumor complexity in these cases.9 RPN appears to have extended the reach of LPN, enabling PN to be performed in more complex scenarios and by a greater number of proficient surgeons.The published evidence has suggested that RPN can likely be performed with a favorable risk-benefit profile relative to OPN for well-selected patients. 3,[11][12][13] This present report confirms these prior reports.14 Peyronnet et al. report in this issue of Annals of Surgical Oncology that RPN is associated with favorable perioperat...

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Comparison of 1800 Robotic and Open Partial Nephrectomies for Renal Tumors

Abstract: In this study, RPN was less morbid than OPN, with lower complications, less blood loss, and a shorter hospital of stay. The intermediate-term oncologic outcomes were similar in the two groups.

Cited by 146 publications

References 28 publications

Is postoperative Doppler ultrasonography useful for the early detection of asymptomatic pseudoaneurysm and prevention of haemorrhagic complications after partial nephrectomy?

Is postoperative Doppler ultrasonography useful for the early detection of asymptomatic pseudoaneurysm and prevention of haemorrhagic complications after partial nephrectomy?

Open versus robotic partial nephrectomy: Systematic review and meta‐analysis of contemporary studies

Comparison of 1800 Robotic and Open Partial Nephrectomies for Renal Tumors

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