Intraoperative cyst rupture of partial nephrectomy for cystic renal masses: does it increase the risk of recurrence?

Our objective was to assess the prevalence of intraoperative cyst rupture (CR) and its impact on oncological outcomes.

All patients who underwent PN for a cystic renal masse through an open (OPN) or robot-assisted (RAPN) approach at eight academic institutions were included in a retrospective study. All operative reports were carefully reviewed and any description of cyst rupture, cyst effraction or local spillage intraoperatively was recorded as CR. Multivariate logistic regression analysis was used to assess the variables associated with CR. Recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS) were estimated using the Kaplan-Meier method and compared with the log-rank test.

Overall, 268 patients were included. There were 50 intraoperative CR in the whole cohort (18.7%). No preoperative parameter was significantly associated with the risk of intraoperative CR in univariate or in multivariate analysis. 75% of cystic renal masses were malignant on final pathology. After a median follow-up of 32 months, five patients had a local recurrence (2.5%), progression to metastasis was observed in 2%, and there were no peritoneal carcinomatosis nor port-site metastases. There were no local or metastatic recurrences in the sub-group of intraoperative CR. Estimated RFS did not differ significantly between patients with vs. without intraoperative CR (Estimated 5-year RFS: 100% vs. 92.7%; p=0.20) CONCLUSION: Intraoperative CR during partial nephrectomy is a relatively common occurence but with little oncological implications.

The Journal of urology. 2018 Jun 20 [Epub ahead of print]

Benjamin Pradere, Benoit Peyronnet, Gauthier Delporte, Quentin Manach, Zine-Eddine Khene, Morgan Moulin, Mathieu Roumiguié, Jérome Rizk, Nicolas Brichart, Jean-Baptiste Beauval, Luc Cormier, Axel Bex, Morgan Rouprêt, Franck Bruyère, Karim Bensalah

Department of Urology, CHU Tours, Tours, France. Electronic address: ., Department of Urology, CHU Rennes, Rennes, France., Department of Urology, CHRU Lille, Lille, France., Department of Urology, Hopital Pitié-Salpetrière, Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, F-75013 PARIS, France., Department of Urology, CHU Dijon, Dijon, France., Department of Urology, CHU Toulouse, Toulouse, France., Department of Urology, CH Orléans, Orléans, France., Department of Urology, Netherlands Cancer Institute, Amsterdam, Netherlands., Department of Urology, CHU Tours, Tours, France.