Complications after partial nephrectomy: robotics overcomes open surgery and laparoscopy: the PMSI French national database

Abstract

Purpose To evaluate three partial nephrectomies (PN) procedures: open (OPN), standard laparoscopy (LPN), and robot-assisted laparoscopy (RAPN), for the risk of initial complications and rehospitalization for two years after the surgery. Materials and methods From the French national hospital database (PMSI-MCO), every hospitalization in French hospitals for renal tumor PN in 2016–2017 were extracted. Complications were documented from the initial hospitalization and any rehospitalization over two years. Chi-square and ANOVA tests compared the frequency of complications and length of initial hospitalization between the three surgical procedures. Relative risks (RR) and 95% confidence intervals were computed. Results The 9119 initial hospitalizations included 4035 OPN, 1709 LPN, and 1900 RAPN; 1475 were excluded as the laparoscopic procedure performed was not determined. The average length of hospitalization was 8.1, 6.2, and 4.5 days for OPN, LPN, and RAPN, respectively. Compared to OPN, there were fewer complications at the time of initial hospitalization for the mini-invasive procedures: 29% for OPN vs. 20% for LPN (0.70 [0.63;0.78]) and 12% for RAPN (RR=0.43, 95%CI [0.38;0.49]). For RAPN compared to LPN, there were fewer haemorrhages (RR=0.55 [0.43;0.72]), anemia (0.69 {0.48;0.98]), and sepsis (0.51 [0.36;0.71]); during follow up, there were fewer urinary tract infections (0.64 [0.45;0.91]) but more infectious lung diseases (1.69 [1.03;2.76]). Over the two-year postoperative period, RAPN was associated with fewer acute renal failures (RR=0.73 [0.55;0.98]), renal abscesses (0.41 [0.23;0.74]), parietal complications (0.69 [0.52;0.92]) and urinary tract infections (0.54 [0.40;0.73]) than for OPN. Conclusions Conservative renal surgery is associated with postoperative morbidity related to the surgical procedure fashion. Mini-invasive procedures, especially robot-assisted surgery, had fewer complications and shorter hospital lengths of stay

The Transabdominal Lumbar Approach (TALA) for Robotic Renal Surgery—A Retrospective Single-Center Comparative Study and Step-by-Step Description of a Novel Approach

“…The 15% grade III-V complication rate suggests opportunities to improve safety outcomes. Additionally, the grade >2 complication rate of 6.47% was somewhat higher compared to a big reference French national data base [15]. Again, the numbers from our study should be contextualized, as they reflect the complication rate at the beginning of the learning curve, and it is well known that the rate of severe complications is higher in the initial phase before reaching the plateau phase [16].…”

Open, laparoscopic, and robotic techniques for partial nephrectomy for renal cell carcinoma: a comparison of outcomes based on "trifecta" and "pentafecta" criteria

“…Данные в литературе неоднородны [2 -7, 14, 15] и имеют ряд ограничений (моноцентровые исследования, критерии выборочного включения, небольшой размер выборки пациентов, только экспертные центры). К примеру, в последнем отчёте Национального управления здравоохранения Франции о применении робот-ассистированной хирургии почки в 2019 году было отмечено, что имеющиеся данные не позволяют сделать вывод о клиническом улучшении при роботической методике по сравнению с открытым или лапароскопическим подходом [16].…”