Comparison of retroperitoneal and transperitoneal robotic partial nephrectomy for Pentafecta perioperative and renal functional outcomes

Stroup, Sean P.; Hamilton, Zachary; Marshall, Michael; Lee, Hak J.; Berquist, Sean; Hassan, Abd-Elrahman Said; Beksaç, Alp Tuna; Field, Charles; Bloch, Aaron; Wan, Fang; McDonald, Matthew J.; Patel, Nishant; L’Esperance, James O.; Derweesh, Ithaar

doi:10.1007/s00345-017-2062-0

Cited by 45 publications

(49 citation statements)

References 30 publications

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“…These findings were comparable to results from prior studies and were because of the advantages of directly approaching the kidney without bowel mobilization in the retroperitoneal approach. 16,[22][23][24][25] RRPN was associated with benefits of shorter WIT ( p = 0.008) and lower EBL ( p = 0.003) in all patients, although no differences were seen in patients with ‡4 cm renal tumors. Shorter WIT and lower EBL could affect functional outcomes and are regarded as prominent factors in RPN.…”

Section: Discussionmentioning

confidence: 91%

“…A single study compared TRPN and RRPN by Pentafecta criteria, but found variations in surgical procedures owing to multiple surgeons operating in two different centers. 16 Trifecta criteria were generated by Hung and colleagues as WIT £25 minutes, negative surgical margins, and no urological complications. 18 Pentafecta criteria added >90% preservation of baseline eGFR and no upgrading of CKD stage.…”

Section: Discussionmentioning

confidence: 99%

“…15 Multiple studies compared Pentafecta outcomes after partial nephrectomy; however, only a single study compared transperitoneal robotic partial nephrectomy (TRPN) and retroperitoneal robotic partial nephrectomy (RRPN) using Pentafecta outcomes. 16 We found no comparative study using Pentafecta criteria on large renal tumors.…”

Section: Introductionmentioning

confidence: 93%

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Comparison by Pentafecta Criteria of Transperitoneal and Retroperitoneal Robotic Partial Nephrectomy for Large Renal Tumors

Choi

Kang

Sung

et al. 2020

Journal of Endourology

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Objective: To compare and analyze surgical and functional outcomes of transperitoneal robotic partial nephrectomy (TRPN) and retroperitoneal robotic partial nephrectomy (RRPN) in localized renal tumors, including ‡4 cm renal masses. Methods: Of 566 consecutive patients who underwent robotic partial nephrectomy by a single surgeon from December 2008 through July 2017, records for 523 patients who were preoperatively and 1 year postoperatively evaluated were analyzed for estimated glomerular filtration rate (eGFR). Primary endpoint was a comparison of Pentafecta criteria (negative surgical margin, no 30-day complications, warm ischemic time [WIT] £25 minutes, return of eGFR to >90% from baseline, and no upstaging of chronic kidney disease) between TRPN and RRPN. Secondary endpoint was finding predictors for Pentafecta achievement. Results: In all 523 patients, these Pentafecta criteria were lower for RRPN than TRPN: operation time ( p < 0.001), WIT ( p = 0.008), and estimated blood loss ( p = 0.003). In patients with ‡4 cm renal tumors, only operation time was faster in RRPN than TRPN ( p = 0.032). RRPN demonstrated more eGFR decrease in all patients ( p = 0.006) and patients with ‡4 cm renal tumors ( p = 0.008). Pentafecta achievements, complications, and recurrences were not significantly different between TRPN and RRPN in all patients and patients with ‡4 cm renal tumors. Multivariable analysis revealed baseline hemoglobin ( p = 0.013) and tumor size ( p < 0.001) were predictive for Pentafecta achievement. Conclusions: Pentafecta achievement was similar for TRPN and RRPN. Baseline hemoglobin and tumor size were predictors of Pentafecta achievement. RRPN was properly performed for anterolateral renal tumor.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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Comparison by Pentafecta Criteria of Transperitoneal and Retroperitoneal Robotic Partial Nephrectomy for Large Renal Tumors

Choi

Kang

Sung

et al. 2020

Journal of Endourology

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“…12 Stroup and colleagues reported similar result of a shorter operative time using a retroperitoneal approach and better utility in posterior tumors. 13 Our study has several limitations. First, this study was retrospective in nature, was conducted at a single institution, and included a population of tertiary care patients.…”

Section: Discussionmentioning

confidence: 91%

“…The feasibility of a retroperitoneal approach in RAPN has been evaluated in several studies. 12,13 Choo and colleagues compared surgical outcomes between transperitoneal RAPN and retroperitoneal RAPN with matched-pair comparisons by nephrometry score and demonstrated that retroperitoneal RAPN had a shorter operative time, but perioperative results were generally equivalent to those of transperitoneal RAPN. 12 Stroup and colleagues reported similar result of a shorter operative time using a retroperitoneal approach and better utility in posterior tumors.…”

Section: Discussionmentioning

confidence: 99%

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

Kondo

Yoshida

et al. 2018

Journal of Endourology

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Retroperitoneal or transperitoneal approach in robot‐assisted partial nephrectomy, which one is better?

et al. 2021

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PurposeTo systematically assess the perioperative outcomes of retroperitoneal (RP) and transperitoneal (TP) approaches in robot‐assisted partial nephrectomy (RAPN), we conducted an updated meta‐analysis.MethodsA literature retrieval of multi‐database including PubMed, Web of Science, Embase, Cochrane Library, and CNKI was performed to identify eligible comparative studies from the inception dates to January 2021. Perioperative outcomes included operative time (OT), estimated blood loss (EBL), warm ischemia time (WIT), postoperative length of stay (PLOS), positive surgical margin (PSM), and complications (major complications and overall complications). Outcomes of data were pooled and analyzed with Review Manager 5.4.1.ResultsTwenty‐one studies involving a total of 2482 RP and 3423 TP approach RAPN patients met the inclusion criteria. Operating time (OT) (weighted mean difference [WMD] −16.60; 95% confidence interval [CI] −23.08, −10.12; p < 0.01) and PLOS (WMD −0.46 days; 95% CI −0.69, −0.23; p < 0.01) were shorter in RP‐RAPN. Besides, lower EBL (WMD −21.67; 95% CI −29.74, −13.60; p < 0.05) was also found in RP‐RAPN. Meanwhile, no significant differences were found in other outcomes.ConclusionsRP‐RARN was superior to TP‐RAPN in patients undergoing RAPN in terms of OT, PLOS, and estimated blood loss. Besides these two approaches have no significant differences in PSMs or perioperative complications.

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Comparison of retroperitoneal and transperitoneal robotic partial nephrectomy for Pentafecta perioperative and renal functional outcomes

Abstract: TRPN and RRPN have similar quality outcomes, though RRPN may offer modest benefit for operative time and have utility in posterior tumors. Association of increasing RENAL score and decreased baseline eGFR with lack of Pentafecta suggests dominant role of non-modifiable factors.

Cited by 45 publications

References 30 publications

Comparison by Pentafecta Criteria of Transperitoneal and Retroperitoneal Robotic Partial Nephrectomy for Large Renal Tumors

Comparison by Pentafecta Criteria of Transperitoneal and Retroperitoneal Robotic Partial Nephrectomy for Large Renal Tumors

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

Retroperitoneal or transperitoneal approach in robot‐assisted partial nephrectomy, which one is better?

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