While partial nephrectomy (PN) represents the standard surgical management for cT1 renal masses, its role for cT2 tumors is controversial. Robot-assisted PN (RAPN) is being increasingly implemented worldwide.
To analyze perioperative, functional, and oncological outcomes of RAPN for cT2 tumors.
Retrospective analysis of a large multicenter, multinational dataset of patients with nonmetastatic cT2 masses treated with robotic surgery (ROSULA: RObotic SUrgery for LArge renal mass).
Patients' demographics, lesion characteristics, perioperative variables, renal functional data, pathology, and oncological data were analyzed. Univariable and multivariable regression analyses assessed the relationships with the risk of intra-/postoperative complications, recurrence, and survival.
A total of 298 patients were analyzed. Median tumor size was 7.6 (7-8.5) cm. Median RENAL score was 9 (8-10). Median ischemia time was 25 (20-32) min. Median estimated blood loss was 150 (100-300) ml. Sixteen patients had intraoperative complications (5.4%), whereas 66 (22%) had postoperative complications (5% were Clavien grade ≥3). Multivariable analysis revealed that a lower RENAL score (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.21-0.65, p=0.02) and pathological pT2 stage (OR 0.51, 95% CI 0.12-0.86, p=0.001) were protective against postoperative complications. A total of 243 lesions (82%) were malignant. Twenty patients (8%) had positive surgical margins. Ten deaths and 25 recurrences/metastases occurred at a median follow-up of 12 (5-35) mo. At univariable analysis, higher pT stage was predictive of a likelihood of recurrences/metastases (p=0.048). While there was a significant deterioration of renal function at discharge, this remained stable over time at 1-yr follow-up. The main limitation of this study is its retrospective design.
RAPN in the setting of select cT2 renal masses can safely be performed with acceptable outcomes. Further studies are warranted to corroborate our findings and to better define the role of robotic nephron sparing for this challenging indication.
This report shows that robotic surgery can be used for safe removal of a large renal tumor in a minimally invasive fashion, maximizing preservation of renal function, and without compromising cancer control.
European urology. 2018 May 18 [Epub ahead of print]
Riccardo Bertolo, Riccardo Autorino, Giuseppe Simone, Ithaar Derweesh, Juan D Garisto, Andrea Minervini, Daniel Eun, Sisto Perdona, James Porter, Koon Ho Rha, Alexander Mottrie, Wesley M White, Luigi Schips, Bo Yang, Kenneth Jacobsohn, Robert G Uzzo, Ben Challacombe, Matteo Ferro, Jay Sulek, Umberto Capitanio, Uzoma A Anele, Gabriele Tuderti, Manuela Costantini, Stephen Ryan, Ahmet Bindayi, Andrea Mari, Marco Carini, Aryeh Keehn, Giuseppe Quarto, Michael Liao, Kidon Chang, Alessandro Larcher, Geert De Naeyer, Ottavio De Cobelli, Francesco Berardinelli, Chao Zhang, Peter Langenstroer, Alexander Kutikov, David Chen, Nicolo De Luyk, Chandru P Sundaram, Francesco Montorsi, Robert J Stein, Georges Pascal Haber, Lance J Hampton, Prokar Dasgupta, Michele Gallucci, Jihad Kaouk, Francesco Porpiglia
Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy; Department of Urology, Cleveland Clinic, Cleveland, OH, USA., Division of Urology, Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA. Electronic address: ., Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy., Department of Urology, UCSD Health System, La Jolla, CA, USA., Department of Urology, Cleveland Clinic, Cleveland, OH, USA., Department of Urology, University of Florence, Careggi Hospital, Firenze, Italy., Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA., Division of Urology, IRCCS Fondazione G.Pascale, Naples, Italy., Swedish Urology Group, Seattle, WA, USA., Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea., Department of Urology, OLV Hospital, Aalst, Belgium., Department of Urology, University of Tennessee Medical Center, Knoxville, TN, USA., Department of Urology, Annunziata Hospital, G. D'Annunzio University, Chieti, Italy., Department of Urology, Changhai Hospital, Shanghai, China., Department of Urology, Medical College Wisconsin, Milwaukee, WA, USA., Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA., MRC Centre for Transplantation, NIHR Biomedical Research Centre, Guy's Hospital, King's College, London, UK., Department of Urology, IEO, Milan, Italy., Department of Urology, Indiana University, Indianapolis, IN, USA., Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy., Division of Urology, Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA., Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea., Department of Urology, OLV Hospital, Aalst, Belgium; Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy., Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy.