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

Mihai Dorin Vartolomei, Deliu Victor Matei, Giuseppe Renne, Valeria Maria Tringali, Nicolae Crisan, Gennaro Musi, Francesco Alessandro Mistretta, Andrea Russo, Gabriele Cozzi, Giovani Cordima, Stefano Luzzago, Antonio Cioffi, Ettore Di Trapani, Michele Catellani, Maurizio Delor, Danilo Bottero, Ciro Imbimbo, Vincenzo Mirone, Matteo Ferro, Ottavio de Cobelli

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Nowadays, there is a debate about which surgical treatment should be best for clinical T1 renal tumors. If the oncological outcomes are considered, there are many open and laparoscopic series published. As far as robotic series are concerned, only a few of them report 5-yr oncological outcomes. Objective: The aim of this study was to analyze robot-assisted partial nephrectomy (RAPN) midterm oncological outcomes achieved in a tertiary robotic reference center. Design, setting, and participants: Between April 2009 and September 2013, 123 consecutive patients with clinical T1-stage renal masses underwent RAPN in our tertiary cancer center. Inclusion criteria were as follows: pathologically confirmed renal cell carcinomas (RCCs) and follow-up for >12 mo. Eighteen patients were excluded due to follow-up of <12 mo and 15 due to benign final pathology. Median follow-up was 59 mo (interquartile range 44-73 mo). Patients were followed according to guideline recommendations and institutional protocol. Outcome measurements and statistical analysis: Outcomes were measured by time to disease progression, overall survival, or time to cancer-specific death. Kaplan-Meier method was used to estimate survival; log-rank tests were applied for pair-wise comparison of survival. Results and limitations: From the 90 patients included, 66 (73.3%) had T1a, 12 (13.3%) T1b, three (3.3%) T2a, and nine (10%) T3a tumors. Predominant histological type was clear cell carcinoma: 67 (74.5%). Fuhrmann grade 1 and 2 was found in 73.3% of all malignant tumors. Two patients (2.2%) had positive surgical margins, and complication rate was 17.8%. Relapse rate was 7.7%, including two cases (2.2%) of local recurrences and five (5.5%) distant metastasis. Five-year disease-free survival was 90.9%, 5-yr cancer-specific survival was 97.5%, and 5-yr overall survival was 95.1%. Conclusions: Midterm oncological outcomes after RAPN for localized RCCs (predominantly T1a tumors of low anatomic complexity) were shown to be good, adding significant evidence to support the oncological efficacy and safety of RAPN for the treatment of this type of tumors. Patient summary: 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. We investigated oncological outcomes of 90 patients who underwent robot-assisted partial nephrectomy in our tertiary center after a median follow-up of 59 mo. Our results showed that at 5 yr cancer-specific survival was 97.5%, disease-free survival was 90.9%, while overall survival was 95.1%.

Original languageEnglish
JournalEuropean Urology Focus
DOIs
Publication statusAccepted/In press - Jan 1 2017

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Nephrectomy
Survival
Neoplasms
Robotics
Kidney
Renal Cell Carcinoma
Disease-Free Survival
Recurrence
Disease Progression
Therapeutics
Guidelines
Pathology
Neoplasm Metastasis
Carcinoma
Safety

Keywords

  • Mid-term oncological outcome
  • Partial nephrectomy
  • Renal cell carcinoma
  • Robot assisted

ASJC Scopus subject areas

  • Urology

Cite this

Robot-assisted Partial Nephrectomy : 5-yr Oncological Outcomes at a Single European Tertiary Cancer Center. / Vartolomei, Mihai Dorin; Matei, Deliu Victor; Renne, Giuseppe; Tringali, Valeria Maria; Crisan, Nicolae; Musi, Gennaro; Mistretta, Francesco Alessandro; Russo, Andrea; Cozzi, Gabriele; Cordima, Giovani; Luzzago, Stefano; Cioffi, Antonio; Di Trapani, Ettore; Catellani, Michele; Delor, Maurizio; Bottero, Danilo; Imbimbo, Ciro; Mirone, Vincenzo; Ferro, Matteo; de Cobelli, Ottavio.

In: European Urology Focus, 01.01.2017.

Research output: Contribution to journalArticle

@article{9a74457ab7f04439ab8c1f510edad470,
title = "Robot-assisted Partial Nephrectomy: 5-yr Oncological Outcomes at a Single European Tertiary Cancer Center",
abstract = "Background: Nowadays, there is a debate about which surgical treatment should be best for clinical T1 renal tumors. If the oncological outcomes are considered, there are many open and laparoscopic series published. As far as robotic series are concerned, only a few of them report 5-yr oncological outcomes. Objective: The aim of this study was to analyze robot-assisted partial nephrectomy (RAPN) midterm oncological outcomes achieved in a tertiary robotic reference center. Design, setting, and participants: Between April 2009 and September 2013, 123 consecutive patients with clinical T1-stage renal masses underwent RAPN in our tertiary cancer center. Inclusion criteria were as follows: pathologically confirmed renal cell carcinomas (RCCs) and follow-up for >12 mo. Eighteen patients were excluded due to follow-up of <12 mo and 15 due to benign final pathology. Median follow-up was 59 mo (interquartile range 44-73 mo). Patients were followed according to guideline recommendations and institutional protocol. Outcome measurements and statistical analysis: Outcomes were measured by time to disease progression, overall survival, or time to cancer-specific death. Kaplan-Meier method was used to estimate survival; log-rank tests were applied for pair-wise comparison of survival. Results and limitations: From the 90 patients included, 66 (73.3{\%}) had T1a, 12 (13.3{\%}) T1b, three (3.3{\%}) T2a, and nine (10{\%}) T3a tumors. Predominant histological type was clear cell carcinoma: 67 (74.5{\%}). Fuhrmann grade 1 and 2 was found in 73.3{\%} of all malignant tumors. Two patients (2.2{\%}) had positive surgical margins, and complication rate was 17.8{\%}. Relapse rate was 7.7{\%}, including two cases (2.2{\%}) of local recurrences and five (5.5{\%}) distant metastasis. Five-year disease-free survival was 90.9{\%}, 5-yr cancer-specific survival was 97.5{\%}, and 5-yr overall survival was 95.1{\%}. Conclusions: Midterm oncological outcomes after RAPN for localized RCCs (predominantly T1a tumors of low anatomic complexity) were shown to be good, adding significant evidence to support the oncological efficacy and safety of RAPN for the treatment of this type of tumors. Patient summary: 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. We investigated oncological outcomes of 90 patients who underwent robot-assisted partial nephrectomy in our tertiary center after a median follow-up of 59 mo. Our results showed that at 5 yr cancer-specific survival was 97.5{\%}, disease-free survival was 90.9{\%}, while overall survival was 95.1{\%}.",
keywords = "Mid-term oncological outcome, Partial nephrectomy, Renal cell carcinoma, Robot assisted",
author = "Vartolomei, {Mihai Dorin} and Matei, {Deliu Victor} and Giuseppe Renne and Tringali, {Valeria Maria} and Nicolae Crisan and Gennaro Musi and Mistretta, {Francesco Alessandro} and Andrea Russo and Gabriele Cozzi and Giovani Cordima and Stefano Luzzago and Antonio Cioffi and {Di Trapani}, Ettore and Michele Catellani and Maurizio Delor and Danilo Bottero and Ciro Imbimbo and Vincenzo Mirone and Matteo Ferro and {de Cobelli}, Ottavio",
year = "2017",
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issn = "2405-4569",
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TY - JOUR

T1 - Robot-assisted Partial Nephrectomy

T2 - 5-yr Oncological Outcomes at a Single European Tertiary Cancer Center

AU - Vartolomei, Mihai Dorin

AU - Matei, Deliu Victor

AU - Renne, Giuseppe

AU - Tringali, Valeria Maria

AU - Crisan, Nicolae

AU - Musi, Gennaro

AU - Mistretta, Francesco Alessandro

AU - Russo, Andrea

AU - Cozzi, Gabriele

AU - Cordima, Giovani

AU - Luzzago, Stefano

AU - Cioffi, Antonio

AU - Di Trapani, Ettore

AU - Catellani, Michele

AU - Delor, Maurizio

AU - Bottero, Danilo

AU - Imbimbo, Ciro

AU - Mirone, Vincenzo

AU - Ferro, Matteo

AU - de Cobelli, Ottavio

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background: Nowadays, there is a debate about which surgical treatment should be best for clinical T1 renal tumors. If the oncological outcomes are considered, there are many open and laparoscopic series published. As far as robotic series are concerned, only a few of them report 5-yr oncological outcomes. Objective: The aim of this study was to analyze robot-assisted partial nephrectomy (RAPN) midterm oncological outcomes achieved in a tertiary robotic reference center. Design, setting, and participants: Between April 2009 and September 2013, 123 consecutive patients with clinical T1-stage renal masses underwent RAPN in our tertiary cancer center. Inclusion criteria were as follows: pathologically confirmed renal cell carcinomas (RCCs) and follow-up for >12 mo. Eighteen patients were excluded due to follow-up of <12 mo and 15 due to benign final pathology. Median follow-up was 59 mo (interquartile range 44-73 mo). Patients were followed according to guideline recommendations and institutional protocol. Outcome measurements and statistical analysis: Outcomes were measured by time to disease progression, overall survival, or time to cancer-specific death. Kaplan-Meier method was used to estimate survival; log-rank tests were applied for pair-wise comparison of survival. Results and limitations: From the 90 patients included, 66 (73.3%) had T1a, 12 (13.3%) T1b, three (3.3%) T2a, and nine (10%) T3a tumors. Predominant histological type was clear cell carcinoma: 67 (74.5%). Fuhrmann grade 1 and 2 was found in 73.3% of all malignant tumors. Two patients (2.2%) had positive surgical margins, and complication rate was 17.8%. Relapse rate was 7.7%, including two cases (2.2%) of local recurrences and five (5.5%) distant metastasis. Five-year disease-free survival was 90.9%, 5-yr cancer-specific survival was 97.5%, and 5-yr overall survival was 95.1%. Conclusions: Midterm oncological outcomes after RAPN for localized RCCs (predominantly T1a tumors of low anatomic complexity) were shown to be good, adding significant evidence to support the oncological efficacy and safety of RAPN for the treatment of this type of tumors. Patient summary: 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. We investigated oncological outcomes of 90 patients who underwent robot-assisted partial nephrectomy in our tertiary center after a median follow-up of 59 mo. Our results showed that at 5 yr cancer-specific survival was 97.5%, disease-free survival was 90.9%, while overall survival was 95.1%.

AB - Background: Nowadays, there is a debate about which surgical treatment should be best for clinical T1 renal tumors. If the oncological outcomes are considered, there are many open and laparoscopic series published. As far as robotic series are concerned, only a few of them report 5-yr oncological outcomes. Objective: The aim of this study was to analyze robot-assisted partial nephrectomy (RAPN) midterm oncological outcomes achieved in a tertiary robotic reference center. Design, setting, and participants: Between April 2009 and September 2013, 123 consecutive patients with clinical T1-stage renal masses underwent RAPN in our tertiary cancer center. Inclusion criteria were as follows: pathologically confirmed renal cell carcinomas (RCCs) and follow-up for >12 mo. Eighteen patients were excluded due to follow-up of <12 mo and 15 due to benign final pathology. Median follow-up was 59 mo (interquartile range 44-73 mo). Patients were followed according to guideline recommendations and institutional protocol. Outcome measurements and statistical analysis: Outcomes were measured by time to disease progression, overall survival, or time to cancer-specific death. Kaplan-Meier method was used to estimate survival; log-rank tests were applied for pair-wise comparison of survival. Results and limitations: From the 90 patients included, 66 (73.3%) had T1a, 12 (13.3%) T1b, three (3.3%) T2a, and nine (10%) T3a tumors. Predominant histological type was clear cell carcinoma: 67 (74.5%). Fuhrmann grade 1 and 2 was found in 73.3% of all malignant tumors. Two patients (2.2%) had positive surgical margins, and complication rate was 17.8%. Relapse rate was 7.7%, including two cases (2.2%) of local recurrences and five (5.5%) distant metastasis. Five-year disease-free survival was 90.9%, 5-yr cancer-specific survival was 97.5%, and 5-yr overall survival was 95.1%. Conclusions: Midterm oncological outcomes after RAPN for localized RCCs (predominantly T1a tumors of low anatomic complexity) were shown to be good, adding significant evidence to support the oncological efficacy and safety of RAPN for the treatment of this type of tumors. Patient summary: 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. We investigated oncological outcomes of 90 patients who underwent robot-assisted partial nephrectomy in our tertiary center after a median follow-up of 59 mo. Our results showed that at 5 yr cancer-specific survival was 97.5%, disease-free survival was 90.9%, while overall survival was 95.1%.

KW - Mid-term oncological outcome

KW - Partial nephrectomy

KW - Renal cell carcinoma

KW - Robot assisted

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