Reoperative Partial Nephrectomy—Does Previous Surgical Footprint Impact Outcomes?

Abstract

Purpose: Historically, open techniques have been favored over minimally invasive approaches for complex surgeries. We aimed to identify differences in perioperative outcomes, surgical footprints, and complication rates in patients undergoing either open or robotic reoperative partial nephrectomy. Materials and Methods: A retrospective review of patients undergoing reoperative partial nephrectomy was performed. Patients were assigned to cohorts based on current and prior surgical approaches: open after open, open after minimally invasive surgery, robotic after open, and robotic after minimally invasive surgery cohorts. Perioperative outcomes were compared among cohorts. Factors contributing to complications were assessed. Results: A total of 192 patients underwent reoperative partial nephrectomy, including 103 in the open after open, 10 in the open after minimally invasive surgery, 47 in the robotic after open, and 32 in the robotic after minimally invasive surgery cohorts.The overall and major complication (grade !3) rates were 65% and 19%, respectively. The number of blood transfusions, overall complications, and major complications were significantly lower in robotic compared to open surgical cohorts. On multivariate analysis, the robotic approach was protective against major complications (OR 0.3, p[0.02) and estimated blood loss was predictive (OR 1.03, p[0.004). Prior surgical approach was not predictive for major complications. Conclusions: Reoperative partial nephrectomy is feasible using both open and robotic approaches. While the robotic approach was independently associated with fewer major complications, prior approach was not, implying that prior surgical approaches are less important to perioperative outcomes and in contributing to the overall surgical footprint.

Initial Experience with Hybrid Partial Nephrectomy with Ultrasound-guided Balloon Catheter Occlusion of the Renal Artery for Recurrent Renal Tumors

“…However, PN is much more difficult in the salvage setting in comparison to primary PN. The overall complication rate for repeat robotic or laparoscopic PN increased from 17.6% to 42% [4] , [6] , with the incidence of major complications (defined as Clavien-Dindo grade ≥III) as high as 10% [8] . One of the most common sPN complications was bleeding, with incidence ranging from 5.6% to 23% [4] and a blood transfusion rate of 5.9% [4] , [9] , [10] .…”

Cost Implications of Routine Preoperative Blood Typing and Crossmatching Prior to Robot-Assisted Laparoscopic Partial Nephrectomy

“…RAPN at our institution is primarily performed for stage pT1 tumors, and our cohort does not include a significant number of pT2, post-ablation or reoperative RAPN procedures, and this likely lowered our overall transfusion rate. 22 Patients who had bleeding events and were admitted to other facilities may not have been accurately captured in this cohort because we are a tertiary referral center. Intraoperative hemorrhage necessitating open conversion or completion nephrectomy was not assessed in this review.…”

“…Characteristics by group reports were not uniform in level of detail provided, and therefore the utilization of artery and vein clamping or offclamp techniques cannot be fully quantified. RAPN at our institution is primarily performed for stage pT1 tumors, and our cohort does not include a significant number of pT2, postablation or reoperative RAPN procedures, and this likely lowered our overall transfusion rate 22. Patients who had bleeding events and were admitted to other facilities may not have been accurately captured in this cohort because we are a tertiary referral center.…”

This Month in Adult Urology

“…In the multicenter study by Gurram et al (539), the authors compared repeat partial nephrectomy via either an open or a robotic approach. 3 They found a significant decrease in grade 3 or greater complications in favor of robotic surgery, as well as decreased blood loss. Major complications were no different regardless of whether the first operation was robotic or open.…”