Tumor Enucleation vs Sharp Excision in Minimally Invasive Partial Nephrectomy: Technical Benefit Without Impact on Functional or Oncologic Outcomes

Mukkamala, Anudeep; Allam, Christopher; Ellison, Jonathan S.; Hafez, Khaled S.; Miller, David C.; Montgomery, Jeffrey S.; Weizer, Alon Z.; Wolf, J. Stuart

doi:10.1016/j.urology.2014.02.007

Cited by 46 publications

(46 citation statements)

References 13 publications

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“…10,19 On the contrary, the present study did not show any protective role of SE on surgical postoperative complications. Several explanations can be provided: first, the surgical technique was not recorded using the SIB margin score, a newly developed system that aims to standardize the reporting of surgical techniques, 20 while all data were registered according to the surgeon-intention.…”

Section: Discussioncontrasting

confidence: 99%

Predictive factors of overall and major postoperative complications after partial nephrectomy: Results from a multicenter prospective study (The RECORd 1 project)

Mari

Antonelli

Bertolo

et al. 2017

European Journal of Surgical Oncology (EJSO)

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Introduction and objectives: To analyze postoperative complications and to assess for significant predictive factors during partial nephrectomy (PN) using a large multicenter dataset. Conclusions: Comorbidities and surgical approach should be considered in preoperative evaluation of patients undergoing PN, as they resulted to play a significant role in the occurrence of postoperative complications.

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Section: Discussioncontrasting

confidence: 99%

Predictive factors of overall and major postoperative complications after partial nephrectomy: Results from a multicenter prospective study (The RECORd 1 project)

Mari

Antonelli

Bertolo

et al. 2017

European Journal of Surgical Oncology (EJSO)

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“…Fundamentally, the minimal-margin approach is similar, albeit theoretically safer, to tumor enucleation, a technique with equivalent 10-yr cancer-specific survival compared with excisional PN [17]. Mukkamala et al recently reported on 86 patients treated by minimally invasive enucleation PN and showed a trend toward lower warm ischemia but no detectable difference in functional outcomes [18]. However, in this series, the hilum was clamped in >60% of patients.…”

Section: Discussionmentioning

confidence: 69%

Robotic Unclamped “Minimal-margin” Partial Nephrectomy: Ongoing Refinement of the Anatomic Zero-ischemia Concept

Satkunasivam¹,

Tsai²,

Syan³

et al. 2015

European Urology

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“…Indeed, in the recent years, prospective and retrospective studies from many groups have consistently demonstrated that SE achieves optimal oncologic outcomes and have confirmed that it is at least non-inferior to standard PN (enucleoresection and resection) in terms of positive margin and local recurrence rate for Please cite this article in press as: Mari 22,24]. Even the most recent EAU Guidelines do not recommend a safe margin that need to be resected along with the tumor during PN to achieve oncological efficacy [2].…”

Section: Discussionmentioning

confidence: 96%

Impact of the off-clamp endoscopic robot-assisted simple enucleation (ERASE) of clinical T1 renal tumors on the postoperative renal function: Results from a matched-pair comparison

Mari

Morselli

Sessa

et al. 2018

European Journal of Surgical Oncology

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a b s t r a c tPurpose: To evaluate the surgical and functional outcomes of a matched-paired series of on-clamp vs offclamp endoscopic robot-assisted simple enucleation (ERASE) and standardized renorraphy in a tertiary referral institution, to search for predictors of functional drop after surgery and to investigate the influence of off-clamp technique in patients presenting these characteristics. Materials and methods: A matched-pair comparison of 120 on-clamp vs 120 off-clamp over 491 patients treated with ERASE was performed. Perioperative and functional outcomes were compared between groups. Results: Patients treated with on-clamp and off-clamp technique had comparable complication and positive surgical margin rate. The off-clamp group had a significantly lower eGFR drop compared to the on-clamp group at 3rd postoperative day (POD) (1% vs 7%, p ¼ 0.0001) and at 30th POD (2.5% vs 9%, p ¼ 0.01) from baseline. This difference lost its statistical significance at 6th month and at last follow-up (median 40 months). At multivariable analysis the Charlson comorbidity index (OR 2.06, p < 0.0001), uncontrolled type 2 diabetes mellitus (OR 4.13, p < 0.001) were independent predictive factors of a >15% eGFR drop from baseline to last follow-up. In a subanalysis over 64 comorbid patients, those patients who underwent off-clamp ERASE had a significantly lower eGFR drop compared to the comorbid counterpart during the whole follow-up. Conclusions: The off-clamp ERASE is a safe surgical technique with a significantly lower renal function drop compared to on-clamp ERASE in the early perioperative time. Patients with comorbidity might represent a subgroup of patients having a functional benefit after off-clamp RAPN even in the long-term period.

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Tumor Enucleation vs Sharp Excision in Minimally Invasive Partial Nephrectomy: Technical Benefit Without Impact on Functional or Oncologic Outcomes

Cited by 46 publications

References 13 publications

Predictive factors of overall and major postoperative complications after partial nephrectomy: Results from a multicenter prospective study (The RECORd 1 project)

Predictive factors of overall and major postoperative complications after partial nephrectomy: Results from a multicenter prospective study (The RECORd 1 project)

Robotic Unclamped “Minimal-margin” Partial Nephrectomy: Ongoing Refinement of the Anatomic Zero-ischemia Concept

Impact of the off-clamp endoscopic robot-assisted simple enucleation (ERASE) of clinical T1 renal tumors on the postoperative renal function: Results from a matched-pair comparison

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