Laparoscopic partial nephrectomy for endophytic hilar tumors: feasibility and outcomes

Pierro, Giovanni Battista Di; Tartaglia, Nicola; Aresu, Luca; Polara, Andrea; Cielo, Adriana; Cristini, C.; Grande, Pietro; Gentile, Vincenzo; Grosso, G.

doi:10.1016/j.ejso.2013.11.023

Cited by 20 publications

(8 citation statements)

References 11 publications

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“…The constantly improved surgical technique and better understanding of biologic characteristics of renal tumor have led to the prosperity of minimally invasive techniques . LPN, a feasible and effective treatment for selected endophytic hilar tumors in highly experienced hands, could be more challenging when treating more complex renal tumors. Due to the main superiority of robotic surgery, RPN was considered as a widely accepted alternative to open PN and LPN when surgically treating renal tumors .…”

Section: Discussionmentioning

confidence: 99%

Robot‐assisted versus laparoscopic partial nephrectomy for anatomically complex T1b renal tumors with a RENAL nephrometry score ≥7: A propensity score‐based analysis

Deng

Liu

et al. 2019

Cancer Medicine

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Objectives:To present the perioperative, functional, and oncological outcomes of robot-assisted partial nephrectomy (RPN) compared with laparoscopic partial nephrectomy (LPN) for anatomically complex T1b renal tumors with RENAL nephrometry scores ≥7. Patients and methods: One hundred and seventy patients, during the study period, were retrospectively reviewed in our analysis according to inclusion criteria.Propensity score matching (PSM) (1:1) method was applied to impose restrictions on the potential baseline confounders. The comparisons of perioperative and functional outcomes between the RPN and LPN groups were conducted and analyzed after PSM, Kaplan-Meier analyses were performed to assess the differences about oncological outcomes between the two groups before and after PSM. Results: One hundred and nine and 61 T1b renal tumors with RENAL scores ≥7 were identified in the LPN and RPN groups, respectively. All significant differences in baseline characteristics disappeared after PSM. Except for 3 patients missing an appropriate pair, all the patients in the RPN group were successfully matched to 58 patients in the LPN group in a 1:1 ratio. Within the matched cohort, the RPN group was related to a significantly shorter mean operating time (OT) (P = .040), shorter mean warm ischemia time (WIT) (P = .023), and shorter median postoperative hospital stay (P = .023). The possibilities of surgical conversion, postoperative complication, and positive surgical margin were similar in the LPN and RPN groups.And there was also no significant difference in the pathological, renal functional, and oncological outcomes between the two series. Conclusions: For patients with anatomically complex T1b renal tumors with a RENAL nephrometry score ≥7, RPN had an advantage over LPN in reducing OT, WIT, and postoperative hospital stay length without increasing the risk of | 587 DENG Et al.

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Section: Discussionmentioning

confidence: 99%

Robot‐assisted versus laparoscopic partial nephrectomy for anatomically complex T1b renal tumors with a RENAL nephrometry score ≥7: A propensity score‐based analysis

Deng

Liu

et al. 2019

Cancer Medicine

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“…As the application of PN continues to expand, the vast majority of patients presenting with a renal mass may eventually be offered some form of nephron‐sparing surgery. Although LPN represents a feasible, safe and effective treatment for selected patients diagnosed with endophytic hilar masses for advanced laparoscopic expertise , LPN is technically demanding and can be particularly challenging for more complex tumours. The advent of robot technology appears to be particularly important for a further expansion of the indications of minimally invasive nephron‐sparing surgery, allowing a safer and more precise excision of larger tumours.…”

Section: Discussionmentioning

confidence: 99%

Comparison of robot‐assisted and laparoscopic partial nephrectomy for complex renal tumours with a RENAL nephrometry score ≥7: peri‐operative and oncological outcomes

Wang

Huang

et al. 2015

BJU International

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ObjectiveTo evaluate the peri-operative, functional and oncological outcomes of robot-assisted partial nephrectomy (RAPN) and laparoscopic partial nephrectomy (LPN) for moderately or highly complex tumours (defined as RENAL nephrometry score ≥7). Patients and MethodsWe retrospectively analysed the medical charts of 216 patients with complex tumours who underwent LPN (n = 135) or RAPN (n = 81) between 2008 and 2014. Peri-operative data, pathological variables, complications, functional and oncological outcomes were reviewed. ResultsDemographic characteristics were similar in the two groups. LPN was associated with a longer operating time (149.6 vs 135.6 min; P = 0.017) and greater estimated blood loss (220.8 vs 196.5 mL; P = 0.013). RAPN was associated with a higher direct cost. There were no differences in warm ischaemia time, transfusion rate, conversion rate, hospital stay, operative complications and estimated glomerular filtration rate change at 6 months after surgery. The mean follow-ups for LPN and RAPN were 31.4 and 16.5 months, respectively. The 3-year recurrence-free survival rate was 95.2% for LPN and 97.1% for RAPN (P = 0.71). ConclusionIn patients with complex tumours, RAPN and LPN provided acceptable and similar results in terms of peri-operative, functional and oncological outcomes. RAPN was superior to LPN in terms of estimated blood loss and operating time, and LPN was the more cost-effective approach. Both surgery techniques remain viable options in the management of complex tumours with RENAL scores ≥7.

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“…Conversely, Di Pierro et al [6] did not report any conversion to radical nephrectomy, in a small series of endophytic tumors, performed by an expert laparoscopic surgeon at a single Italian center. However, 9.7% of treated cases required a conversion to laparoscopic radical nephrectomy.…”

Section: Laparoscopic Partial Nephrectomymentioning

confidence: 92%

Outcomes and limitations of laparoscopic and robotic partial nephrectomy

Ficarra¹,

Rossanese²,

Gnech³

et al. 2014

Current Opinion in Urology

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Laparoscopic partial nephrectomy for endophytic hilar tumors: feasibility and outcomes

Cited by 20 publications

References 11 publications

Robot‐assisted versus laparoscopic partial nephrectomy for anatomically complex T1b renal tumors with a RENAL nephrometry score ≥7: A propensity score‐based analysis

Robot‐assisted versus laparoscopic partial nephrectomy for anatomically complex T1b renal tumors with a RENAL nephrometry score ≥7: A propensity score‐based analysis

Comparison of robot‐assisted and laparoscopic partial nephrectomy for complex renal tumours with a RENAL nephrometry score ≥7: peri‐operative and oncological outcomes

Outcomes and limitations of laparoscopic and robotic partial nephrectomy

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