TY - JOUR
T1 - Outcomes of robot-assisted partial nephrectomy for completely endophytic renal tumors
T2 - A multicenter analysis
AU - Carbonara, Umberto
AU - Simone, Giuseppe
AU - Minervini, Andrea
AU - Sundaram, Chandru P
AU - Larcher, Alessandro
AU - Lee, Jennifer
AU - Checcucci, Enrico
AU - Fiori, Cristian
AU - Patel, Devin
AU - Meagher, Margaret
AU - Crocerossa, Fabio
AU - Veccia, Alessandro
AU - Hampton, Lance J
AU - Ditonno, Pasquale
AU - Battaglia, Michele
AU - Brassetti, Aldo
AU - Bove, Alfredo
AU - Mari, Andrea
AU - Campi, Riccardo
AU - Carini, Marco
AU - Sulek, Jay
AU - Montorsi, Francesco
AU - Capitanio, Umberto
AU - Eun, Daniel
AU - Porpiglia, Francesco
AU - Derweesh, Ithaar
AU - Autorino, Riccardo
N1 - Copyright © 2020 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
PY - 2020/8/16
Y1 - 2020/8/16
N2 - INTRODUCTION: Multicenter retrospective analysis of robotic partial nephrectomy for completely endophytic renal tumors (i.e. 3 points for the 'E' domain of the R.E.N.A.L. nephrometry score) was performed.MATERIALS AND METHODS: Patients' demographics, tumor characteristics, perioperative, functional, pathological and oncological data were analyzed and compared with those of patients with exophytic and mesophytic masses (i.e. 1 and 2 points for the 'E' domain, respectively). Multivariable logistic regression analysis was used to assess variables for trifecta achievement (negative margin, no postoperative complications, and 90% estimated glomerular filtration rate [eGFR] recovery).RESULTS: Overall, 147 patients were included in the study group. Patients with a completely endophytic mass had bigger tumors (mean 4.2 vs. 4.1 vs. 3.2 cm; p < 0.001) on preoperative imaging and higher overall R.E.N.A.L. score. There was no difference in mean operative time. Estimated blood loss was higher in the endophytic group (mean 177.75 vs. 185.5 vs. 130 ml; p = 0.001). Warm ischemia time was shorter for the exophytic group (median 16 vs. 21 vs. 22 min; p < 0.001). Postoperative complications were more frequent in patients with endophytic tumor (24.8% vs. 19.5% vs. 14.8%; p < 0.001). Six (4.5%) patients had positive surgical margins, there was no difference between groups. Trifecta was achieved in 44 patients in endophytic group (45.4 vs. 68.8 and 50.9%, p < 0.001). Multivariable analysis for trifecta revealed that clinical tumor size (odds ratio: 0.667, 95% confidence interval: 0.56-0.79, p < 0.001) was only significant predictor for trifecta achievement.CONCLUSIONS: Our findings confirm that RAPN in case of completely endophytic renal masses can be performed with acceptable outcomes in centers with significant robotic expertise.
AB - INTRODUCTION: Multicenter retrospective analysis of robotic partial nephrectomy for completely endophytic renal tumors (i.e. 3 points for the 'E' domain of the R.E.N.A.L. nephrometry score) was performed.MATERIALS AND METHODS: Patients' demographics, tumor characteristics, perioperative, functional, pathological and oncological data were analyzed and compared with those of patients with exophytic and mesophytic masses (i.e. 1 and 2 points for the 'E' domain, respectively). Multivariable logistic regression analysis was used to assess variables for trifecta achievement (negative margin, no postoperative complications, and 90% estimated glomerular filtration rate [eGFR] recovery).RESULTS: Overall, 147 patients were included in the study group. Patients with a completely endophytic mass had bigger tumors (mean 4.2 vs. 4.1 vs. 3.2 cm; p < 0.001) on preoperative imaging and higher overall R.E.N.A.L. score. There was no difference in mean operative time. Estimated blood loss was higher in the endophytic group (mean 177.75 vs. 185.5 vs. 130 ml; p = 0.001). Warm ischemia time was shorter for the exophytic group (median 16 vs. 21 vs. 22 min; p < 0.001). Postoperative complications were more frequent in patients with endophytic tumor (24.8% vs. 19.5% vs. 14.8%; p < 0.001). Six (4.5%) patients had positive surgical margins, there was no difference between groups. Trifecta was achieved in 44 patients in endophytic group (45.4 vs. 68.8 and 50.9%, p < 0.001). Multivariable analysis for trifecta revealed that clinical tumor size (odds ratio: 0.667, 95% confidence interval: 0.56-0.79, p < 0.001) was only significant predictor for trifecta achievement.CONCLUSIONS: Our findings confirm that RAPN in case of completely endophytic renal masses can be performed with acceptable outcomes in centers with significant robotic expertise.
U2 - 10.1016/j.ejso.2020.08.012
DO - 10.1016/j.ejso.2020.08.012
M3 - Article
C2 - 32868149
JO - Eur. J. Surg. Oncol.
JF - Eur. J. Surg. Oncol.
SN - 0748-7983
ER -