Comparison of 1800 Robotic and Open Partial Nephrectomies for Renal Tumors

Abstract

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...

Nephron sparing surgery for the treatment of renal masses: A single center experience

“…[15][16][17][18] As demonstrated in previous studies, the advantages of RAPN consist of lower blood loss and surgical complication rates, as well as shorter hospital stay, learning curve and WIT. 16,19 These findings were confirmed in the current series.…”

Are there limits of robotic partial nephrectomy? TRIFECTA outcomes of open and robotic partial nephrectomy for completely endophytic renal tumors

“…Nevertheless, this development is believed to further pave the way for an increase in the use of nephron sparing surgery over radical nephrectomy . Especially for small renal masses, robotic assisted partial nephrectomy (RAPN) is considered to be a valuable alternative to open partial nephrectomy (OPN) with fewer complications and shorter hospitalization times …”

“…4 Especially for small renal masses, robotic assisted partial nephrectomy (RAPN) is considered to be a valuable alternative to open partial nephrectomy (OPN) with fewer complications and shorter hospitalization times. 5 However, for entirely endophytic and complex tumors, OPN still seems to remain the preferred technique. 3,6 Potential reasons include the lack of haptic feedback in robotic surgery as well as a superior spatial access to the renal mass simplifying intraoperative ultrasonography and faster hemostasis by manual compression during OPN.…”

Robot-assisted partial nephrectomy for clinically localized renal cell carcinoma

“…в 2016 г. [18], в котором авторы проанализировали серию из 1800 пациентов, перенесших РАРП и открытую резекцию почки (ОРП) за период с 2006 по 2014 г. в шести центрах. В группе РАРП авторами пока-зано сокращение частоты осложнений до 18% по сравнению с группой, перенесшей ОРП, где частота осложнений составила 28,6% (p<0,001).…”

“…Кроме того, в группе РАРП авторы отметили сокращение ВТИ (15,7 мин против 18,6 мин; p<0,001) и продолжительности госпитализации (4,7 сут против 10,1 сут; p<0,001). Опухолеспецифическая и общая выживаемость в обеих группах данного исследования не различались [18]. В результатах преобладающего количества публикаций можно также увидеть уменьшение кровопотери, сокращение ВТИ и продолжительности операции при роботической резекции почки [10][11][12][13][14].…”