Comparison of Kidney Function in the Early Postoperative Period in Transperitoneal Robot-Assisted Laparoscopic Partial Nephrectomy Between Anterior and Posterior Renal Tumors: A Propensity Score-Matched Study

Takagi, Toshio; Kondo, Tsunenori; Yoshida, Kazuhiko; Kobayashi, Hirohito; Iizuka, Junpei; Okumi, Masayoshi; Ishida, Hideyuki; Tanabe, Kazunari

doi:10.1089/end.2017.0654

Cited by 11 publications

(11 citation statements)

References 13 publications

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“…Three surgeons carried out transperitoneal RAPN as previously described . Briefly, the surgeries were carried out using an arterial clamp with warm ischemia, as well as three robotic arms and two or three assistant ports.…”

Section: Methodsmentioning

confidence: 99%

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Peritumoral pseudocapsule status according to pathological characteristics from robot‐assisted laparoscopic partial nephrectomy for localized renal cell carcinoma

et al. 2019

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Objective To investigate peritumoral pseudocapsule status in patients with renal cell carcinoma who underwent robot‐assisted laparoscopic partial nephrectomy, and to examine predictive factors associated with the absence of peritumoral pseudocapsule. Methods A total of 367 patients with clinical T1 renal cell carcinoma who underwent robot‐assisted laparoscopic partial nephrectomy were divided into two groups according to peritumoral pseudocapsule status. The groups were compared in terms of patient and tumor characteristics. Multivariate logistic regression analysis was carried out to identify predictive factors for the absence of peritumoral pseudocapsule. Results Of the 367 tumors, 323 (88%) were surrounded by a peritumoral pseudocapsule. The mean tumor size was 30 mm, and 70% of the patients were male. Tumors with a peritumoral pseudocapsule had a larger diameter than those without (31 vs 26 mm; P = 0.0008). A peritumoral pseudocapsule was observed in 92% of the clear cell, in 89% of the papillary and in 86% of the clear cell papillary renal cell carcinoma cases compared with just 50% in the chromophobe renal cell carcinoma cases (P < 0.0001). Sex, age, Fuhrman grade and tumor complexity did not differ among patients. A multivariate analysis showed that smaller tumor size (≥34 vs <34 mm, odds ratio 3.31; P = 0.0023) and chromophobe renal cell carcinoma (vs other subtypes, odds ratio 12.5; P < 0.0001) predicted an absence of peritumoral pseudocapsule. Conclusions Small tumor size and chromophobe renal cell carcinoma were significant predictors of a lack of peritumoral pseudocapsule, suggesting that a positive surgical margin must be avoided for these tumors when an enucleation technique is used for robot‐assisted laparoscopic partial nephrectomy.

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Section: Methodsmentioning

confidence: 99%

“…Three surgeons carried out transperitoneal RAPN as previously described. 12 Briefly, the surgeries were carried out using an arterial clamp with warm ischemia, as well as three robotic arms and two or three assistant ports. The tumor was excised by standard resection or enucleation according to its position or the surgeon's preference.…”

Section: Surgerymentioning

confidence: 99%

Peritumoral pseudocapsule status according to pathological characteristics from robot‐assisted laparoscopic partial nephrectomy for localized renal cell carcinoma

et al. 2019

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“…Meta-analysis of new-onset CKD was feasible for the RENAL score only, but it did not predict it (p = 0.086; Table 2 and the Supplementary material) [38,41,70]. In terms of renal function variation, continuous [18,70] and categorical RENAL scores [19,63] were independent predictors of an estimated glomerular filtration rate (eGFR) increase (OR: 1.28; 95% CI: 1.07, 1.53; p = 0.006, and OR: 5.64; 95% CI: 2.22, 14.32; p < 0.001, respectively). A pooled analysis was not feasible for the other nephrometry scores because only one study per nephrometry score was available.…”

Section: Postoperative Renal Functionmentioning

confidence: 99%

Predictive Value of Nephrometry Scores in Nephron-sparing Surgery: A Systematic Review and Meta-analysis

Veccia

Antonelli

Uzzo

et al. 2020

European Urology Focus

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Context: Over the last decade, several nephrometry scores (NSs) have been introduced with the aim of facilitating preoperative decision making, planning, and counseling in the field of nephron-sparing surgery. However, their predictive role remains controversial. Objective: To describe currently available nephrometry scores and to determine their predictive role for different outcomes by performing a systematic review and metaanalysis of the literature. Evidence acquisition: PubMed, Embase1, and Web of Science were screened to identify eligible studies. Identification and selection of the reports were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). A pooled analysis of NS predictive role of intraoperative, postoperative, oncological, and functional outcomes was performed. Odds ratio was considered the effect size. All the analyses were performed using Stata 15.0, and statistical significance was set at p 0.05. Evidence synthesis: Overall, 51 studies meeting our inclusion criteria were identified and considered for the analysis. Except for one prospective randomized trial, all the studies were retrospective. All the studies were found to be of intermediate quality, except for one of high quality. Most studies assessed the predictive role of the Radius-Exophytic/Endophytic-Nearness-Anterior/Posterior-Location (RENAL) and Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) scores, mostly regarding complications after nephron-sparing surgery. RENAL was an independent predictor of an on-clamp procedure (p < 0.001). Mayo Adhesive Probability score was related to adhesive perinephric fat (p = 0.005). Continuous and high-complexity RENAL scores were predictors of warm ischemia time (WIT; p = 0.006 and p < 0.001, respectively). Continuous (p < 0.001) and high-complexity (p < 0.001) PADUA scores were related to WIT. Continuous and high-complexity RENAL scores were predictors of overall complications (p = 0.002 and p < 0.001, respectively). PADUA score was related to complications both as continuous (p < 0.001) and as a categorical value (p < 0.002). The RENAL scores R = 3 (p = 0.008), E = 2 (p = 0.039), and hilar location (p = 0.006) were predictors of histological malignancy. Continuous and categorical RENAL scores were independent

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“…Three surgeons carried out transperitoneal RAPN, as previously described . Briefly, an arterial clamp with warm ischemia, as well as three robotic arms and two or three assistant ports were used.…”

Section: Methodsmentioning

confidence: 99%

“…Three surgeons carried out transperitoneal RAPN, as previously described. 13 Briefly, an arterial clamp with warm ischemia, as well as three robotic arms and two or three assistant ports were used. Although no definitive indication for the enucleation was used in this study, this technique was more frequently carried out for complex tumors or depending on surgeons' preference.…”

Section: Surgerymentioning

confidence: 99%

Association between tumor contact surface area and parenchymal volume change in robot‐assisted laparoscopic partial nephrectomy carried out using the enucleation technique

et al. 2019

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Objective To evaluate the change in the operated parenchymal volume during robot‐assisted partial nephrectomy limited to the enucleation technique, and to analyze the predictors of decrease in operated parenchymal volume, including the tumor contact surface area. Methods The study included 135 patients who underwent robot‐assisted partial nephrectomy for T1 renal tumors using the enucleation technique. Measurements of the parenchymal volume, tumor volume and contact surface area were obtained in the venous phase on enhanced computed tomography. All measurements, including volumetric and renal function analysis, were carried out <2 months before and 6 months after surgery. Results The mean age of included participants was 56 years, and the mean tumor size was 33 mm. The mean tumor volume was 26 cc, and the mean contact surface area was 22 cm2. In the complete cohort, the mean preoperative and postoperative normal parenchymal volumes of the operated kidney were 158 and 141 cc, respectively. The mean change in parenchymal volume of the operated kidney was −10%. In contrast, the mean change in global estimated glomerular filtration was just −4.0%. Univariate analysis showed that the RENAL nephrometry score, contact surface area, tumor volume and warm ischemia time were associated with the change in the operated kidney parenchymal volume. However, in the multivariate analysis, a large contact surface area was the only independent predictor of decreased operated parenchymal volume <10 cm3. Conclusion Contact surface area is a strong predictor of the decrease in the parenchymal volume in the operated kidney during robot‐assisted partial nephrectomy carried out using the enucleation technique for T1 renal tumors.

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Comparison of Kidney Function in the Early Postoperative Period in Transperitoneal Robot-Assisted Laparoscopic Partial Nephrectomy Between Anterior and Posterior Renal Tumors: A Propensity Score-Matched Study

Abstract: Posterior tumors had a greater decrease in early postoperative nadir eGFR than anterior tumors, with equivalent surgical outcomes, including similar renal function, 6 to 12 months after surgery in the setting of transperitoneal RAPN.

Cited by 11 publications

References 13 publications

Peritumoral pseudocapsule status according to pathological characteristics from robot‐assisted laparoscopic partial nephrectomy for localized renal cell carcinoma

Peritumoral pseudocapsule status according to pathological characteristics from robot‐assisted laparoscopic partial nephrectomy for localized renal cell carcinoma

Predictive Value of Nephrometry Scores in Nephron-sparing Surgery: A Systematic Review and Meta-analysis

Association between tumor contact surface area and parenchymal volume change in robot‐assisted laparoscopic partial nephrectomy carried out using the enucleation technique

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