Achieving Tumor Control when Suspecting Sinus Fat Involvement during Robotic Partial Nephrectomy: Step-by-Step

to report a single expert robotic surgeon step-by-step surgical technique for achieving local cancer control during robotic PN (RPN) for T3 tumors.

Since January 2010 to December 2016, the institutional RPN database was queried for patients who underwent transperitoneal RPN performed by a single-surgeon for tumors ≤ 4 mm from the collecting system at preoperative computed tomography (3 points on the "N (Nearness)" RENAL-score item) that were pT3a involving sinus fat at final pathology. Baseline characteristics, perioperative and oncological outcomes (particularly positive surgical margins, PSMs).

Out of 1497 masses that underwent RPN, 512 had 3 points on the N item of the RENAL score assessment. 24 patients had pT3a tumor involving sinus fat at final pathology and represented the analyzed cohort. RPN were performed according to the here described technique. No PSM was reported. Trifecta achievement was 54.2%. Within a median follow-up of 30 months, 2 and 1 patients had recurrence or metastasis, respectively. 2 patients died unrelated to renal cancer. Retrospective analysis and limited follow-up represent study limitations.

in a selected cohort of patients with renal tumors near the sinus fat at baseline RENAL score assessment and confirmed pT3a at final pathology, the described RPN technique was able to achieve optimal local cancer control. This article is protected by copyright. All rights reserved.

BJU international. 2018 Sep 26 [Epub ahead of print]

Riccardo Bertolo, Juan Garisto, Daniel Sagalovich, Julien Dagenais, Jose Agudelo, Jihad Kaouk

Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.