Robot‐assisted partial nephrectomy for high‐complexity tumors (PADUA score ≥10): Perioperative, long‐term functional and oncologic outcomes

Abstract

To evaluate the safety and efficacy, and long-term functional and oncologic outcomes of robot-assisted partial nephrectomy in high-complexity tumors. Methods: Data of 155 patients with a high-complexity tumor (PADUA score ≥10) were reviewed. Trifecta achievement, intra-, perioperative, functional, and oncologic outcomes were analyzed and compared between patients with increasing complexity. Results: Of the 155 patients, 65 (41.9%) patients had a PADUA score of 10, 55 (35.5%) had a PADUA score of 11, and 35 (22.6%) had a PADUA score of 12-13, respectively. The median (interquartile range) operative time, warm ischemia time and estimated blood loss were 150 min (112-186 min), 26 min (23-32 min) and 250 mL (100-500 mL), respectively. Postoperatively, complications occurred in 25 (16.1%) patients, and positive surgical margins in 15 (10.5%) patients. Trifecta was achieved in 67 (43.2%) patients. At a median follow-up period of 58 months, the median estimated glomerular filtration rate preservation was 87% (78-110), and 12 (7.7%) patients developed new-onset chronic kidney disease. Recurrence-free survival and overall survival rates were 93.6% and 96.7%, respectively. Positive surgical margins were statistically different between the groups of PADUA score 10, 11 and 12-13 (P = 0.017), whereas functional and oncologic outcomes were similar. In multivariate logistic regression analysis, increasing tumor size (odds ratio 1.48, 95% confidence interval 1.21-1.87; P < 0.001) and the American Society of Anesthesiologists score 2/3 (odds ratio 0.48, 95% confidence interval 0.24-0.96; P = 0.041) were independent predictors of trifecta failure. Conclusions: Robot-assisted partial nephrectomy is a safe and effective treatment for high-complexity tumors providing excellent long-term functional and oncologic outcomes.

Robot-Assisted Partial Nephrectomy Mid-Term Oncologic Outcomes: A Systematic Review

“…After fulfilling all the inclusion criteria, 13 studies were identified [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ], and another 17 studies were excluded mainly because follow-up was too short [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. All of the studies had an retrospective design except the ones from Furukawa et al [ 16 ] and Beauval et al [ 24 ].…”

“…Mean tumor size ranged from 2.6 to 4.2 cm. Follow-ups ranged from 49 to 88, and only 4 studies had a shorter than 60 month follow-up [ 17 , 21 , 22 , 25 ]. Reported positive surgical margin rates ranged from 0 to 10.5%.…”

How far has robot-assisted partial nephrectomy reached?

“…If each of the two classes is 10 points or more, it is considered as a high-complexity group. Based on these classifications, there are several reports of high-complexity renal tumors ( Table 1 ) [ 15 16 17 18 19 ].…”

“…To evaluate outcomes of PN, a trifecta is generally used and is defined as WIT <25 min, negative surgical margins, and no intraoperative or postoperative major complications (Clavien–Dindo grade ≥3) [ 20 ]. Koukourikis et al [ 17 ] reported a 43.2% trifecta achievement rate of RAPN in high-complexity tumors (PADUA score ≥10). Nevertheless, it showed excellent long-term functional and oncologic outcomes over a median follow-up period of 58 months (87% eGFR preservation, 93.6% recurrence-free survival, and 96.7% overall survival rates), and RAPN was suggested to be a safe and effective treatment option [ 17 ].…”

“…Koukourikis et al [ 17 ] reported a 43.2% trifecta achievement rate of RAPN in high-complexity tumors (PADUA score ≥10). Nevertheless, it showed excellent long-term functional and oncologic outcomes over a median follow-up period of 58 months (87% eGFR preservation, 93.6% recurrence-free survival, and 96.7% overall survival rates), and RAPN was suggested to be a safe and effective treatment option [ 17 ]. Abdel Raheem et al [ 18 ] reported a 37.5% trifecta achievement rate for a PADUA score of ≥10 after RAPN.…”