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Robotic partial nephrectomy for clinical T2a renal mass is associated with improved trifecta outcome compared to open partial nephrectomy: a single surgeon comparative analysis

  • Fady Ghali
  • Amr A. Elbakry
  • Zachary A. Hamilton
  • Kendrick Yim
  • Ryan Nasseri
  • Sunil Patel
  • Ahmed Eldefrawy
  • Stephen Ryan
  • Aaron W. Bradshaw
  • Margaret Meagher
  • Kelly Bree
  • Madhumitha Reddy
  • Hak J. Lee
  • Ithaar H. DerweeshEmail author
Topic Paper

Abstract

Objective

Utilization of partial nephrectomy (PN) for T2 renal mass is controversial due to concerns regarding burden of morbidity, though most cited data are from open PN (OPN). We compared surgical quality and functional outcomes of RPN and OPN for clinical T2a renal masses (cT2aRM).

Methods

Retrospective analysis of 150 consecutive patients [RPN 59/OPN 91] who underwent PN from July 2008 to June 2016. Main outcome was achievement of Trifecta [negative surgical margin, no major urologic complications, and ≥90% preservation of estimated glomerular filtration rate (eGFR)]. Multivariable analysis was performed to identify factors of Trifecta attainment.

Results

Mean tumor size (RPN 7.9 vs. OPN 8.4 cm, p = 0.139) and median RENAL score (p = 0.361) were similar. No difference was noted for positive margins (RPN 3.4% vs. OPN 1.1%, p = 0.561), ΔeGFR (RPN − 6.2 vs. OPN − 7.8, p = 0.543), and ≥ 90% eGFR recovery (RPN 54.1% vs. OPN 47.2%, p = 0.504). RPN had lower blood loss (p = 0.015), hospital stay (p = 0.013), and Clavien ≥ 3 complications (RPN 5.1% vs. OPN 16.5%, p = 0.041). Trifecta rate was significantly higher in RPN (47.5% vs. 34.0%, p = 0.041). Multivariable analysis demonstrated decreasing RENAL score (OR 1.11, p < 0.001), RPN (OR 1.2, p = 0.013), and decreasing EBL (OR 1.02, p = 0.016) to be associated with Trifecta attainment.

Conclusions

RPN provided similar functional and oncologic precision to OPN, while being associated with improvements in major complications, the latter of which was reflected in a higher rate of Trifecta achievement for RPN. RPN may be considered to be a first-line option for select patients with cT2aRM when feasible and safe.

Keywords

Carcinoma, renal cell Complications Partial nephrectomy Outcome Robotic partial nephrectomy Trifecta 

Notes

Author contributions

FG: Project development, manuscript writing/editing, data analysis. AAE: Project development, manuscript writing, data analysis. ZAH: Project development, data analysis, manuscript editing. KY: Data collection, manuscript writing/editing. RN: Data analysis, manuscript writing/editing. SP: Data collection and management, manuscript writing/editing. AE: Data management, manuscript editing. SR: Data management and analysis. AB: Data collection and analysis. MM: Data collection and analysis, manuscript editing. KB: Data collection and management. MR: Data management and analysis. HJL: Project development, data management. ID: Protocol/project development and manuscript writing/editing.

Funding

This article was supported by the Stephen Weissman Kidney Cancer Research Fund.

Compliance with ethical standards

Conflict of interest

None of the authors have any conflict of interest to declare.

Ethical standards

Have been met; study is IRB approved at all institutions.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Fady Ghali
    • 1
  • Amr A. Elbakry
    • 1
  • Zachary A. Hamilton
    • 1
  • Kendrick Yim
    • 1
  • Ryan Nasseri
    • 1
  • Sunil Patel
    • 1
  • Ahmed Eldefrawy
    • 1
  • Stephen Ryan
    • 1
  • Aaron W. Bradshaw
    • 1
  • Margaret Meagher
    • 1
  • Kelly Bree
    • 1
  • Madhumitha Reddy
    • 1
  • Hak J. Lee
    • 1
  • Ithaar H. Derweesh
    • 1
    Email author
  1. 1.Department of UrologyUC San Diego School of MedicineLa JollaUSA

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