Robot-assisted Partial Nephrectomy: 5-yr Oncological Outcomes at a Single European Tertiary Cancer Center

Vartolomei, Mihai Dorin; Matei, Deliu Victor; Renne, Giuseppe; Tringali, V.; Crişan, Nicolae; Musi, Gennaro; Mistretta, Francesco A.; Russo, Andrea; Cozzi, Guido; Cordima, Giovani; Luzzago, Stefano; Cioffi, Antonio; Trapani, Ettore Di; Catellani, Michele; Delor, M.; Bottero, Danilo; Imbimbo, Ciro; Mirone, Vincenzo; Ferro, Matteo; Cobelli, Ottavio De

doi:10.1016/j.euf.2017.10.005

Cited by 24 publications

(16 citation statements)

References 35 publications

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“…However, oncologic survival data is not reported. Several contemporary studies have reported excellent five-year oncologic outcomes for RAPN; however, these studies document outcomes for smaller patient cohorts compared to the present study and do not report oncologic outcomes with respect to surgical margin status (21)(22)(23)(24). In the current study we present longterm oncologic outcomes for a larger cohort of patients with renal cortical neoplasms exclusively managed by RAPN.…”

Section: Discussioncontrasting

confidence: 54%

Long-term oncologic outcomes of positive surgical margins following robot-assisted partial nephrectomy

Rothberg¹,

Peak²,

Reynolds³

et al. 2020

Transl Androl Urol

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Background: Previous reports on positive surgical margin (PSM) after robot-assisted partial nephrectomy (RAPN) have reached inconsistent conclusions as to the impact of a PSM on oncologic outcomes. We sought to determine the effect of PSM on long-term cancer recurrence and survival outcomes. Methods: We queried our renal oncology database for patients having undergone RAPN and compared recurrence-free survival (RFS) and overall survival (OS) between patients with PSM and negative surgical margin (NSM). Kaplan-Meier analysis was also performed for RFS and OS for PSM versus NSM. Results: Of the 432 patients who underwent RAPN we identified 29 (6.7%) patients with PSM and 403 (93.3%) patients with NSM. Median follow-up for the overall cohort was 45.1 months. Three of the 29 patients with PSM and fourteen of the 403 patients with NSM had disease recurrence (P=0.09).RFS at 24, 48, and 72 months was 95.8%, 90%, and 85.5% for patients with NSM and 96.6%, 86.6%, and 80.4% for patients with PSM, respectively (log-rank P value =0.382). OS at 24, 48, and 72 months was 98%, 93.1%, and 89.7% for patients with NSM and 96.3%, 91.2%, and 85.2% for patients with PSM, respectively (log-rank P value =0.584).Conclusions: While PSM are relatively uncommon, their presence still serves as a potential risk factor for worse oncologic outcomes. In instances of PSM, immediate secondary intervention is most likely unnecessary and more attentive long-term clinical follow-up, especially in patients with high-risk features, may be more advisable.

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Section: Discussioncontrasting

confidence: 54%

Long-term oncologic outcomes of positive surgical margins following robot-assisted partial nephrectomy

Rothberg¹,

Peak²,

Reynolds³

et al. 2020

Transl Androl Urol

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“…However, as the surgeon's experience with RALPN increased, the indication for RALPN expanded, eventually becoming the standard procedure for T1a and T1b RCC at our institution. Other studies have also reported similar data [19,20]. In our early period, tumors < 4 cm in diameter were suitable for the robotic platform, but tumors > 4 cm in size were also treated with RALPN in the later periods.…”

Section: Discussionsupporting

confidence: 78%

Factors influencing warm ischemia time in robot-assisted partial nephrectomy change depending on the surgeon’s experience

Numakura

Kobyashi

Koizumi

et al. 2022

Preprint

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INTRODUCTION: Warm ischemia time (WIT) is a primary concern for robot-assisted laparoscopic partial nephrectomy (RALPN) patients because longer WIT is significantly associated with postoperative deteriorating kidney function. Tumor complexity, determined by the RENAL nephrometry score (RENAL score), can help predict surgical outcomes, but it is unclear what RENAL score and clinical factors affect WIT. This study explored the clinical factors predicting long WIT in RALPN.MATERIALS AND METHODS: In our institute, 174 RALPNs were performed between November 2013 and February 2021, of which 114 were performed by a single surgeon and included in this study. Clinical staging and the total RENAL score were determined based on preoperative CT scans. The cases were divided into three groups based on experience: period 1: 1–38, period 2: 39–76, and period 3: 77–114. The clinical factors associated with longer WIT were analyzed per period. RESULTS: The overall median tumor diameter was 32 mm, and one patient had a positive surgical margin, but there were no cancer-related deaths. In total, there were 18 complications (15.8 %). Periods 2 and 3 had larger tumor diameters (p<0.01) and worse preoperative kidney function (p=0.029) than period 1. A RENAL L-component score of 3 was associated with longer WIT in period 3 (odds ratio: 3.900; 95 % confidence interval: 1.004–15.276; p = 0.044), but the tumor diameter and the total RENAL score were not.CONCLUSIONS: A large tumor in the central lesion indicated by the RENAL L-component score was associated with increased WIT in RALPN.

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“…Fiveyear survival outcomes are favorable with 5-year overall survival >90% and cancer-free survival approaching 98%. This is in addition to a decreased complication rate of 17%-24% compared to 30% for OPN (13)(14)(15). Success has also been seen in complex cases such as solitary functioning kidneys as demonstrated by Arora et al, who achieved the surgical trifecta of minimal warm ischemia time, minimal perioperative complications, and negative surgical margins in the majority of excised lesions (16).…”

Section: Advancements In Partial Nephrectomymentioning

confidence: 93%

“…Multiple series have revealed that robotic‐assisted partial nephrectomy (RAPN) of small renal masses ≤4 cm affords outcomes at least equal to OPN . Five‐year survival outcomes are favorable with 5‐year overall survival >90% and cancer‐free survival approaching 98%.…”

Section: Advancements In Partial Nephrectomymentioning

confidence: 99%

Recent advancements of robotic surgery for kidney cancer

Phung

Lee

2018

Asian J Endoscop Surgery

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Surgical management of renal cell carcinoma has undergone a transformation in recent decades, especially with the dissemination of the robotic platform. Increasingly, larger and more complex renal lesions are now being treated in a minimally invasive fashion. The purpose of this article is to review advances in the use of the robotic approach for treatment of renal cell carcinoma, including nephron-sparing surgery, radical nephrectomy, and cytoreductive nephrectomy.

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Robot-assisted Partial Nephrectomy: 5-yr Oncological Outcomes at a Single European Tertiary Cancer Center

Abstract: Robot-assisted partial nephrectomy seems to be the most promising minimally invasive approach in the treatment of renal masses suitable for organ-sparing surgery as midterm (5 yr) oncological outcomes are excellent.

Cited by 24 publications

References 35 publications

Long-term oncologic outcomes of positive surgical margins following robot-assisted partial nephrectomy

Long-term oncologic outcomes of positive surgical margins following robot-assisted partial nephrectomy

Factors influencing warm ischemia time in robot-assisted partial nephrectomy change depending on the surgeon’s experience

Recent advancements of robotic surgery for kidney cancer

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