Predictors of Warm Ischemia Time and Perioperative Complications in a Multicenter, International Series of Robot-Assisted Partial Nephrectomy

Ficarra, Vincenzo; Bhayani, Sam B.; Porter, James R.; Buffi, Nicolò Maria; Lee, Robin; Cestari, Andrea; Mottrie, Alexandre

doi:10.1016/j.eururo.2011.10.046

Cited by 146 publications

(109 citation statements)

References 20 publications

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“…score in the preoperative assessment of RALPN has previously been highlighted. 15,19,20 As expected, this score was significantly correlated with the WIT, operative time, estimated blood loss and complication rate. 21 Surgery for a deep endophytic hilar mass will be more technically challenging than that for an exophytic lower pole T1a tumour.…”

Section: Discussionsupporting

confidence: 80%

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Robot-assisted laparoscopic partial nephrectomy: Early single Canadian institution experience

Ploussard

Haddad²,

Kovac³

et al. 2013

CUAJ

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Background: Although robot-assisted partial nephrectomy (RALPN) has been increasingly adopted, open procedures continue to be the reference nephron-sparing technique. We describe our initial surgical outcomes of RALPN in our single institution robotic program. Methods: Between January 2011 and February 2013, 65 consecutive patients underwent a RALPN by 2 surgeons. Preoperative characteristics, including the R.E.N.A.L. nephrometry score, perioperative parameters, and postoperative course, including renal function, were assessed from a retrospective database. The mean follow-up was 12 months. Results: The mean age was 60.2 years and the mean tumour size was 3.9 cm. According to the R.E.N.A.L. nephrometry score, the tumours were classified moderately and highly complex tumours in 51% and 18.5% of cases, respectively. Median warm ischemia time (WIT) was 21 minutes. Factors associated with WIT were R.E.N.A.L. nephrometry score, tumour size, complication rates and surgeon experience. No conversion or grade 4 to 5 complications were reported. The mean hospital stay was 3 days. The overall complication rate was 24.6% (re-admission rate 7.7%), and decreased to 12% after 20 cases. After these initial 20 cases, a trifecta rate (no margins, preserved renal function, no complications) of 64.3% was achieved in moderately and highly complex tumours. The mean change in estimated glomerular filtration rate was 6.7 mL/ min without severe postoperative renal failure. Interpretation: RALPN is a safe and feasible procedure with low specific morbidity, even in moderately or highly complex renal masses. The WIT depends on tumour characteristics, mainly determined by the R.E.N.A.L. nephrometry score and is improved by surgeon experience. Longer follow-up is needed to assess the oncologic mid-term safety of the procedure.

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Section: Discussionsupporting

confidence: 80%

“…19 Despite the increased complexity of tumours, operative time, estimated blood loss and WIT showed a decrease over time as previously described. 23 We used the cut-off of 20 cases, as suggested by Mottrie and colleagues.…”

Section: Discussionmentioning

confidence: 63%

Robot-assisted laparoscopic partial nephrectomy: Early single Canadian institution experience

Ploussard

Haddad²,

Kovac³

et al. 2013

CUAJ

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“…Various multi-institutional studies have evaluated complication rates after RAPN, with rates of overall complications reported to be between 8.5% and 16.2% [18][19][20][21][22]. Only few studies have directly compared open and robot-assisted approaches, and none have focused on outcomes after NSS for clinical T1a tumours.…”

Section: Discussionmentioning

confidence: 99%

Predicting complications in partial nephrectomy for T1a tumours: does approach matter?

et al. 2016

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ObjectivesTo assess differences in complications after robot-assisted (RAPN) and open partial nephrectomy (OPN) among experienced surgeons. Patients and MethodsWe identified patients in our institutional review boardapproved, prospectively maintained database who underwent OPN or RAPN for management of unifocal, T1a renal tumours at our institution between January 2011 and August 2015. The primary outcome measure was the rate of 30-day overall postoperative complications. Baseline patient factors, tumour characteristics and peri-operative factors, including approach, were evaluated to assess the risk of complications. ResultsPatients who underwent OPN were found to have a higher rate of overall complications (30.3% vs 18.2%; P = 0.038), with wound complications accounting for the majority of these events (11.8% vs 1.8%; P < 0.001). Multivariable logistic regression analysis showed the open approach to be an independent predictor of overall complications (odds ratio 1.58, 95% confidence interval 1.03-2.43; P = 0.035). Major limitations of the study include its retrospective design and potential lack of generalizability. ConclusionsThe open surgical approach predicts a higher rate of overall complications after partial nephrectomy for unifocal, T1a renal tumours. For experienced surgeons, the morbidity associated with nephron-sparing surgery may be incrementally improved using the robot-assisted approach.

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“…[2][3][4][5][6] However, only a few reports have evaluated the association between PADUA scores and functional outcomes. In a cohort of 101 patients who underwent laparoscopic partial nephrectomy, moderate-and high-risk groups (PADUA scores of ≥8) exhibited greater percent changes in SCr between baseline and postoperative day 1, than the low-risk group.…”

Section: Discussionmentioning

confidence: 99%

“…1 PADUA scores have been validated to predict warm ischemic time (WIT) and perioperative complications for open, laparoscopic, and robot-assisted partial nephrectomy (RAPN). [2][3][4][5][6] Functional outcome is an important parameter during the surgical planning of renal tumours. Numerous welldocumented variables have been associated with postoperative renal function.…”

Section: Introductionmentioning

confidence: 99%

The association between the anatomical features of renal tumours and the functional outcomes of robot-assisted partial nephrectomy

Lee

Cho

Jeon

et al. 2014

CUAJ

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Cite as: Can Urol Assoc J 2014;8(11-12):e810-4. http://dx.doi.org/10.5489/cuaj.1642 Published online November 24, 2014. AbstractIntroduction: We evaluated the the association between PADUA scores and postoperative renal function (after robot-assisted partial nephrectomy [RAPN]) and between PADUA scores and warm ischemic time (during RAPN). Methods: We reviewed the clinical records of 106 patients who underwent RAPN for a single localized renal tumour between April 2009 and June 2012. Postoperative renal function was evaluated using estimated glomerular filtration rate (eGFR) in 85 patients who were followed for at least 6 months. PADUA scores for renal tumours were calculated using contrast-enhanced computed tomography images, if needed, along with magnetic resonance images in some cases. Results: A PADUA score ≥10 and WIT ≥30 minutes were observed in 18 (17.0%) and 51 (48.1%) cases, respectively. PADUA scores were significantly correlated with WIT (p = 0.019) and percent change in eGFR at 6 months postoperatively (p = 0.005). PADUA score (continuous variable, odds ratio [OR] 1.694, p = 0.007) and the high-risk group (PADUA score ≥10) (OR 5.429; p = 0.020) were significantly associated with a WIT of ≥30 minutes by multivariate analysis. A 1-point increase in the PADUA score was associated with an eGFR decrease of >20% at 6 months after RAPN (OR 1.799; p = 0.076). In addition, a PADUA score ≥10, or high risk, (OR 13.965; p = 0.003) was an independent predictor of an eGFR decrease of >20% at 6 months after RAPN. Conclusions: The PADUA classification can reliably predict WIT and postoperative renal functional outcome after RAPN. Furthermore, the study suggests that anatomical aspects of renal tumours are associated with functional outcome after RAPN.

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Predictors of Warm Ischemia Time and Perioperative Complications in a Multicenter, International Series of Robot-Assisted Partial Nephrectomy

Cited by 146 publications

References 20 publications

Robot-assisted laparoscopic partial nephrectomy: Early single Canadian institution experience

Robot-assisted laparoscopic partial nephrectomy: Early single Canadian institution experience

Predicting complications in partial nephrectomy for T1a tumours: does approach matter?

The association between the anatomical features of renal tumours and the functional outcomes of robot-assisted partial nephrectomy

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