The impact of resection technique on partial nephrectomy (PN) outcomes is controversial. The aim of the study is to evaluate the pattern of resection techniques during PN and their impact on perioperative outcomes, acute kidney injury (AKI), positive surgical margins (PSM) and Trifecta achievement.
Data from consecutive patients with cT1-2N0M0 renal masses treated with PN at 16 referral Centres from September 2014 to March 2015 were prospectively collected. After PN, resection technique was classified by the surgeon as enucleation, enucleoresection and resection according to the SIB score (SIB score 0-2, 3-4 and 5, respectively). Multivariable logistic regression analysis was used to evaluate the potential impact of resection technique on postoperative surgical complications, PSM, AKI and Trifecta achievement.
Overall, 507 patients were included. Resection technique was classified as enucleation in 266 (52%) patients, enucleoresection in 150 (30%) and resection in 91 (18%). Resection technique (enucleoresection as compared to both enucleation and resection) was the only significant predictor of positive surgical margins. Tumor complexity, surgical approach (open and laparoscopic, both compared to robotic) and resection technique (enucleoresection as compared to enucleation) were significant predictors of Clavien-Dindo grade ≥ 2 surgical complications. Surgical approach (open and laparoscopic, both compared to robotic), resection technique (enucleoresection as compared to enucleation) and warm ischemia time were significantly associated with postoperative AKI and Trifecta achievement.
Resection techniques significantly impact on surgical complications, early functional outcomes and positive surgical margins after PN for localized renal masses.
The Journal of urology. 2019 Oct 14 [Epub ahead of print]
Andrea Minervini, Riccardo Campi, Brian R Lane, Ottavio De Cobelli, Francesco Sanguedolce, Georgios Hatzichristodoulou, Alessandro Antonelli, Sabrina Noyes, Andrea Mari, Oscar Rodriguez-Faba, Frank X Keeley, Johan Langenhuijsen, Gennaro Musi, Tobias Klatte, Marco Roscigno, Bulent Akdogan, Maria Furlan, Nihat Karakoyunlu, Martin Marszalek, Umberto Capitanio, Alessandro Volpe, Sabine Brookman-May, Jürgen E Gschwend, Marc C Smaldone, Robert G Uzzo, Marco Carini, Alexander Kutikov, Members of the SIB International Consortium
Department of Urology, University of Florence, Florence, Italy., Department of Urology, Spectrum Health Medical Group, Grand Rapids, Michigan., Department of Urology, European Institute of Oncology (IEO), University of Milan, Milan, Italy., Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom., Department of Urology, Technical University of Munich, University Hospital Klinikum Rechts Der Isar, Munich, Germany., Department of Urology, University of Brescia, Brescia, Italy., Uro-oncology Unit, Fundacio Puigvert, Barcelona, Spain., Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands., Department of Urology, European Institute of Oncology (IEO), Milan, Italy., Department of Urology, Royal Bournemouth Hospital, Bournemouth, United Kingdom., Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy., Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey., Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey., Department of Urology and Andrology, Donauspital, Austria., Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy., Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy., Ludwig-Maximilians University (LMU) Munich, Campus Grosshadern, Dept. of Urology; Janssen Pharma Research and Development, Los Angeles, California., Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia.