Robot‐assisted partial nephrectomy with minimum follow‐up of 5 years: A multi‐center prospective study in Japan

Abstract

Objectives: Robot-assisted partial nephrectomy is widely performed for small renal masses, achieving excellent perioperative and intermediate oncological outcomes. However, long-term oncological, functional, and quality of life outcomes after robotassisted partial nephrectomy remain unclear. In this study, we aimed to evaluate quality of life at 1 year and oncological and functional outcomes of robot-assisted partial nephrectomy after a minimum follow-up of 5 years. Methods: Personal, perioperative, postoperative, functional, oncological, and quality of life data were evaluated. The EQ-5D-5L tool, which incorporates health profiles and a EuroQol Visual Analog Scale, was used to assess quality of life preoperatively and 365 days postoperatively. Regarding oncological and functional outcomes, overall survival, recurrence-free survival, and changes in estimated glomerular filtration rate were calculated. Results: There were few changes in levels between the two time points for all EQ-5D dimensions. The mean change in EQ-5D-5L was 0.020 (95% confidence interval 0.006-0.033, P = 0.006), and in EuroQol Visual Analog Scale score 4.60 (95% confidence interval 2.17-7.02, P = 0.0003). Overall and recurrence-free survival 5 years after robot-assisted partial nephrectomy were 97.9% and 92.8%, respectively. After an early postoperative decrease, the estimated glomerular filtration rate remained stable over time. Conclusions: Robot-assisted partial nephrectomy in patients with a T1 renal tumor is safe, feasible, and effective from the perspective of quality of life and survival, even after 5 years. When making treatment decisions, perioperative and quality of life outcomes should be considered together with long-term oncological 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 ]. The studies included in total 2703 patients with T1 RCC.…”

Editorial Comment to Robot‐assisted laparoscopic versus open partial nephrectomy for renal cell carcinoma in patients with severe chronic kidney disease

“…The long-term results of RAPN were reported in a study in Japan. 2 Yoshida et al reported the perioperative results of PN in severe CKD cases at their institution. Their data were only for a limited number of cases, but their findings included data on the status of transition to end-stage renal disease (ESRD) and the surgical results.…”

“…The development of techniques for minimizing invasiveness in RCC surgery including robot‐assisted PN (RAPN) is progressing. The long‐term results of RAPN were reported in a study in Japan 2 . Yoshida et al.…”

Off‐clamp robot‐assisted partial nephrectomy for renal hilar tumors

“…Robot-assisted partial nephrectomy (RAPN) is the gold standard surgery for patients with cT1 renal tumors in terms of cancer control and preserving renal function. 1 Multiple reports suggest its superiority compared with open or laparoscopic partial nephrectomy, since RAPN can provide exquisite motion control and a magnified view of the surrounding tissues. 1,2 However, surgeons often encounter challenging cT1 tumors.…”

“…1 Multiple reports suggest its superiority compared with open or laparoscopic partial nephrectomy, since RAPN can provide exquisite motion control and a magnified view of the surrounding tissues. 1,2 However, surgeons often encounter challenging cT1 tumors. Renal hilar tumors, in particular, require significantly longer warm ischemia time (WIT), incur greater estimated blood loss, and have higher rates of conversion to open surgery.…”