Outcomes of robot-assisted partial nephrectomy (RAPN) depend on tumor complexity, surgeon experience and patient profile among other variables. We aimed to study the perioperative outcomes of RAPN for patients with complex renal masses using the Vattikuti Collective Quality Initiative (VCQI) database that allowed evaluation of multinational data.
From the VCQI, we extracted data for all the patients who underwent RAPN with preoperative aspects and dimensions used for an anatomical (PADUA) score of ≥10. Multivariate logistic regression was conducted to ascertain predictors of trifecta (absence of complications, negative surgical margins, and warm ischemia times [WIT] <25 min or zero ischemia) outcomes.
Of 3,801 patients, 514 with PADUA scores ≥10 were included. The median operative time, WIT, and blood loss were 173 (range 45-546) min, 21 (range 0-55) min, and 150 (range 50-3500) ml, respectively. Intraoperative complications and blood transfusions were reported in 2.1% and 6%, respectively. In 8.8% of the patients, postoperative complications were noted, and surgical margins were positive in 10.3% of the patients. Trifecta could be achieved in 60.7% of patients. Clinical tumor size, duration of surgery, WIT, and complication rates were significantly higher in the group with a high (12 or 13) PADUA score while the trifecta was significantly lower in this group (48.4%). On multivariate analysis, surgical approach (retroperitoneal vs. transperitoneal) and high PADUA score (12/13) were identified as predictors of the trifecta outcomes.
RAPN may be a reasonable surgical option for patients with complex renal masses with acceptable perioperative outcomes.
Indian journal of urology : IJU : journal of the Urological Society of India. 2022 Oct 01 [Epub]
Gopal Sharma, Milap Shah, Puneet Ahluwalia, Prokar Dasgupta, Benjamin J Challacombe, Mahendra Bhandari, Rajesh Ahlawat, Sudhir Rawal, Nicolo M Buffi, Ananthakrishnan Sivaraman, James R Porter, Craig Rogers, Alexandre Mottrie, Ronney Abaza, Khoon Ho Rha, Daniel Moon, Yuvaraja B Thyavihally, Dipen J Parekh, Umberto Capitanio, Kris K Maes, Francesco Porpiglia, Levent Turkeri, Gagan Gautam
Department of Urologic Oncology, Max Institute of Cancer Care, New Delhi, India., King's Health Partners, Faculty of Life Sciences and Medicine, King's College, London, UK., Department of Urology, Guy's and St. Thomas' Hospital, London, UK., Vattikuti Foundation, Henry Ford Hospital, Detroit, MI, Washington, USA., Department of Urology, Medanta - The Medicity Hospital, New Delhi, India., Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India., Department of Biomedical Sciences, Humanitas University, Milan, Italy., Department of Urooncology, Chennai Urology and Robotics Institute, Chennai, Tamil Nadu, India., Swedish Medical Center, Seattle, Washington, USA., Department of Urology, Henry Ford Hospital, Detroit, MI, Washington, USA., ORSI Academy, Melle, Belgium, Europe., Central Ohio Urology Group, Mount Carmel St. Ann's Hospital, OH, USA., Department of Urology, Yonsei University Health System, Seoul, South Korea., Department of Urology, Royal Melbourne Clinical School, Peter MacCallum Hospital, University of Melbourne, Melbourne, Australia., Department of Urooncology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India., Department of Urology, University of Miami Health System, Miami, FL, USA., Department of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, MI, Washington, USA., Center for Robotics and Minimally Invasive Surgery, Hospital Da Luz, Luz Sáude, Portugal., Department of Urology, San Luigi Gonzaga Hospital of Orbassano, Turin, Italy., Department of Urology, Altuzinade Hospital, Acıbadem M.A. Aydınlar University, Istanbul, Turkey.