Robot-Assisted Partial Nephrectomy for T1b Tumors: Strict Trifecta Outcomes

Overview

Journal JSLS

Specialty General Surgery

Date 2017 Mar 30

PMID 28352149

Citations 10

Authors

Ilter Tufek

Panagiotis Mourmouris

Tunkut Doganca

Can Obek

Omer Burak Argun

Mustafa Bilal Tuna

Mehmet Selcuk Keskin

Ali Riza Kural

Affiliations

Soon will be listed here.

Abstract

Background And Objectives: "Trifecta" in partial nephrectomy consists of negative surgical margins, minimal renal function decrease and absence of complications. In the present article, our single-center robot-assisted partial nephrectomy (RAPN) experience in T1b renal masses is reported in terms of strict Trifecta outcomes.

Methods: This is a retrospective analysis of patients with a tumor diameter between 4 and 7 cm (stage T1b), who underwent RAPN by a single surgeon. Preoperative, intraoperative, and postoperative data were recorded and analyzed to evaluate short-term functional and oncologic outcomes. Patients with absence of grade ≥ 2 Clavien-Dindo complications, warm ischemia time (WIT) ≤25 minutes, ≤15% postoperative estimated glomerular filtration rate (eGFR) decrease and negative surgical margins were reported to achieve strict Trifecta outcomes. < .05 was indicated statistically significant.

Results: A total of 150 patients underwent RAPN, and 50 patients were identified with tumor size between 4 and 7 cm. Mean WIT was 20.8 ± 6.2 minutes and mean estimated blood loss (EBL) was 269 ± 191 mL. Surgical margins were negative in all patients. Eleven patients (22%) had a >15% eGFR decrease after surgery. Nine patients (18%) had WIT longer than 25 minutes. Four patients (8%) had grade ≥2 Clavien-Dindo complications. Twenty-nine (58%) patients had strict Trifecta outcomes. Mean follow-up was 44.2 ± 27.2 months. Tumor recurrence was not observed in any patient.

Conclusions: Robot-assisted laparoscopic partial nephrectomy for T1b renal masses can be safely performed in experienced hands. Optimal strict Trifecta outcomes and recurrence rates can be achieved.

Citing Articles

Impact of tumor contact surface area on collecting system entry in robot-assisted partial nephrectomy: a retrospective analysis.

Umemoto T, Hasegawa M, Yuzuriha S, Kano T, Ogawa T, Kawakami M BMC Urol. 2023; 23(1):85.

PMID: 37158841 PMC: 10165753. DOI: 10.1186/s12894-023-01247-0.

Factors influencing warm ischemia time in robot-assisted partial nephrectomy change depending on the surgeon's experience.

Numakura K, Kobayashi M, Koizumi A, Kashima S, Yamamoto R, Nara T World J Surg Oncol. 2022; 20(1):202.

PMID: 35701769 PMC: 9199197. DOI: 10.1186/s12957-022-02669-0.

Is Preoperative Magnetic Resonance Imaging in a Daily Clinical Setting Useful to Evaluate Tumor Invasion Beyond the Pseudocapsule in Renal Cell Carcinoma?.

Iwamoto H, Nosaka K, Miyoshi H, Makishima K, Ochiai R, Shimizu R Yonago Acta Med. 2021; 64(4):345-352.

PMID: 34849083 PMC: 8612879. DOI: 10.33160/yam.2021.11.004.

Predicting Strict Trifecta Outcomes after Robot-Assisted Partial Nephrectomy: Comparison of RENAL, PADUA, and C-Index Scores.

Karamik K, Aktas Y, Erdemir A, Islamoglu E, Olcucu M, Ozsoy C J Kidney Cancer VHL. 2021; 8(4):1-12.

PMID: 34703725 PMC: 8490181. DOI: 10.15586/jkcvhl.v8i4.183.

Holographic reconstruction technology used for intraoperative real-time navigation in robot-assisted partial nephrectomy in patients with renal tumors: a single center study.

Zeng S, Zhou Y, Wang M, Bao H, Na Y, Pan T Transl Androl Urol. 2021; 10(8):3386-3394.

PMID: 34532263 PMC: 8421827. DOI: 10.21037/tau-21-473.

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