Outcomes and predictors of benign histology in patients undergoing robotic partial or radical nephrectomy for renal masses: A multicenter study

Introduction Theaim of this study was to assess preoperative factors associated with benign histology in patients undergoing surgical removal of a renal mass and to analyze outcomes of robotic partial nephrectomy (PN) and radical nephrectomy (RN) for these masses. Material and methods Overall, 2,944 cases (543 benign and 2,401 malignant) who underwent robotic PN and RN between 2003–2018 at 10 institutions worldwide were included. The assessment of the predictors of benign histology was made at the final surgical pathology report. Descriptive statistics, Mann-Whitney U, Pearson’s χ2, and logistic regression analysis were used. Results Patients in the benign group were mostly female (61 vs. 33%; p <0.001), with lower body mass index (BMI) (26.0 vs. 27.1 kg/m2; p <0.001). The benign group presented smaller tumor size (2.8 vs. 3.5 cm; p <0.001), R.E.N.A.L. score (6.0 vs. 7.0; p <0.001). There was a lower rate of hilar (11 vs.18%; p = 0.001), cT≥3 (1 vs. 4.5%; p <0.001) tumors in the benign group. There was a statistically significant higher rate of PN in the benign group (97 vs. 86%; p <0.001) as well as a statistically significant lower 30-day re-admission rate (2 vs. 5%; p = 0.081). Multivariable analysis showed male gender (OR: 0.52; p <0.001), BMI (OR: 0.95; p <0.001), and cT3a (OR: 0.22; p = 0.005) to be inversely associated to benign histology. Conclusions In 18% of cases, a benign histologic type was found. Only 3% of these tumors were treated with RN. Female gender, lower BMI, and higher T staging showed to be independent predictors of benign histology

Outcomes of minimally invasive partial nephrectomy among very elderly patients: Report from the resurge collaborative international database

The aim of the study was to perform a comprehensive investigation of clinical outcomes of robot-assisted partial nephrectomy (RAPN) or laparoscopic partial nephrectomy (LPN) in elderly patients presenting with a renal mass.The REnal SURGery in Elderly (RESURGE) collaborative database was queried to identify patients aged 75 or older diagnosed with cT1-2 renal mass and treated with RAPN or LPN. Study outcomes were: overall complications (OC); warm ischemia time (WIT) and 6-month estimated glomerular filtration rate (eGFR); positive surgical margins (PSM), disease recurrence (REC), cancer-specific mortality (CSM) and other-cause mortality (OCM). Descriptive statistics, Kaplan-Meier, smoothed Poisson plots and logistic and linear regression models (MVA) were used.Overall, 216 patients were included in this analysis. OC rate was 34%, most of them being of low Clavien grade. Median WIT was 17 minutes and median 6-month eGFR was 54 ml/min/1.73 m(2). PSM rate was 5%. After a median follow-up of 20 months, the 5-year rates of REC, CSM and OCM were 4, 4 and 5%, respectively. At MVA predicting perioperative morbidity, RAPN relative to LPN (odds ratio [OR] 0.33; p &lt;0.0001) was associated with lower OC rate. At MVA predicting functional outcomes, RAPN relative to LPN was associated with shorter WIT (estimate [EST]-4.09; p &lt;0.0001), and with higher 6-month eGFR (EST 6.03; p = 0.01).In appropriately selected patients with small renal masses, minimally-invasive PN is associated with acceptable perioperative outcomes. The use of a robotic approach over a standard laparoscopic approach can be advantageous with respect to clinically relevant outcomes, and it should be preferred when available

Haemostatics in surgery and our experience in the enucleoresection of renal cell carcinoma

<p>Abstract</p> <p>Background</p> <p>30 patients, with T1 renal cell carcinomas (RCC) who underwent open enucleoresection of the tumour, were randomized to the use of a topical haemostatic agent (Floseal) or to an infrared-sapphire coagulator (ISC), to compare their efficacy in achieving haemostasis. Methods: Successful intra-operative haemostasis, intra- and post-operative bleeding, operative time, hospital discharge were evaluated.</p> <p>Results</p> <p>Statistically higher rates of successful haemostasis and shorter time-to-haemostasis (8,1 vs 12,9 min) were observed in the FloSeal group (p < 0.001 both). Patients operative time was not different between Group 1 vs 2 (58.7 ± 12 vs 62.4 ± 15; p > 0.05). The average blood loss during surgery was less (60 +/- 25.5 mL) for the FloSeal group than for the ISC group (85 +/- 40.5 mL) (p < 0.05). Postoperative blood loss was 25 +/- 5 mL and 40 +/- 45 mL for Floseal and ISC respectively, (p < 0.05). Length of the postoperative hospital discharge was 2.5 +/- 1.2 days for FloSeal group and 3.5 +/- 1.3 for the Group 2 (p < 0.05). No major immediate or delayed complications were observed in either Groups.</p> <p>Conclusions</p> <p>The use of Floseal and ISC offer a safe and efficacy haemostasis in the enucleoresection of RCC. Moreover, our results show a less intra-operative and post-operative blood loss as well as a shorter time to haemostasis of Floseal in respect to ISC.</p

Re: The Temporal Association of Robotic Surgical Diffusion with Overtreatment of the Small Renal Mass

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Contemporary minimally invasive surgery for adrenal masses: it's not all about (pure) laparoscopy

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Outcomes of Laparoscopic and Robotic Partial Nephrectomy for Large (>4\ua0Cm) Kidney Tumors: Systematic Review and Meta-Analysis

Purpose: The aim of this study was to assess the outcomes of minimally invasive (laparoscopic and robotic) partial nephrectomy (MIPN) for large renal masses. Materials and Methods: A systematic literature review was performed up to September 2016 using multiple search engines to identify studies comparing MIPN for tumors larger than 4\ua0cm (>cT1a) with MIPN for tumors smaller than 4\ua0cm (cT1a). The preferred reporting items for systematic reviews and meta-analyses (PRISMA) criteria were used for article selection. Baseline demographics and surgical, functional, and oncological parameters were extracted from the included studies whenever available. An overall analysis including all studies was performed, then sensitivity analyses were performed for studies on laparoscopic partial nephrectomy (PN) only, and, finally, for studies on robotic PN only. Results: Overall, 13 case-control studies comparing the outcomes of PN in tumors 4\ua0cm (n\ua0=\ua01024) were included. Warm ischemia time was shorter for the <4\ua0cm group [weighted mean difference (WMD) 3.75\ua0min; 95% confidence interval (CI) 126.4 to 120.7; p\ua0=\ua00.01] and the odds of perioperative complications was lower [odds ratio (OR) 0.62; 95% CI 0.5\u20130.8; p\ua0<\ua00.001]. There were no significant differences in terms of postoperative estimated glomerular filtration rate (WMD 4.2\ua0ml/min; 95% CI 0.45\u20138.97; p\ua0=\ua00.08), as well as onset of postoperative chronic kidney disease (risk ratio 0.71; 95% CI 0.48\u20131.04; p\ua0=\ua00.08). In addition, no difference was found in the likelihood of positive surgical margins (OR 0.74; 95% CI 0.43\u20131.28; p\ua0=\ua00.29). Conclusions: MIPN represents a viable treatment option for renal masses larger than 4\ua0cm (higher than cT1a) as it offers good functional outcomes, without increased risk of positive surgical margins. An increased rate of complications should be taken into account when approaching these tumors

Renal surgery for the older population: time for a paradigm shift? Data from the RESURGE project

Aim To provide a comprehensive analysis of the outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) for renal cell carcinoma (RCC) in older patients. Methods The RESURGE project is a multi-institutional dataset including 24 institutions worldwide collecting data of patients older than 75 years old who underwent RN or PN. Results Among three already published studies, RN patients were older (p &lt; 0.001), and presented a higher RENAL score (p &lt; 0.001). PN showed shorter operative time (p = 0.020), as well as lower eGFR postoperative decline (p &lt; 0.001). No statistically significant difference was found in terms of major complications between PN and RN. PN was shown to be protective factor with respect to de novo chronic kidney disease (CKD) (p &lt; 0.001). RN was related to a higher rate of recurrence (p &lt; 0.001), whereas PN demonstrated lower risk of cancer-specific mortality (CSM) (p = 0.05). Conclusions Data from the RESURGE project suggest that kidney cancer surgery could be feasible and safe in well-selected older patients. When surgery is indicated, PN should be preferred to RN as it offers better functional preservation. Otherwise, less invasive or non-interventional management options should be considered