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World Journal of Urology

, Volume 36, Issue 6, pp 897–904 | Cite as

Long-term oncological outcomes after robotic partial nephrectomy for renal cell carcinoma: a prospective multicentre study

  • Jean-Baptiste Beauval
  • Benoit Peyronnet
  • Thibaut Benoit
  • Bastien Cabarrou
  • Thomas Seisen
  • Mathieu Roumiguié
  • Benjamin Pradere
  • Zine-Eddine Khene
  • Quentin Manach
  • Gregory Verhoest
  • Mathieu Thoulouzan
  • Jerome Parra
  • Nicolas Doumerc
  • Romain Mathieu
  • Christophe Vaessen
  • Michel Soulié
  • Morgan Roupret
  • Karim Bensalah
Original Article

Abstract

Purpose

This study aimed at reporting the long-term oncological outcomes of robotic partial nephrectomy (RPN) for renal cell carcinoma (RCC).

Methods

Data from all consecutive patients who underwent RAPN for RCC from July 2009 to January 2012 in three departments of urology were prospectively collected. Overall survival (OS), cancer-specific survival (CSS) and disease free-survival (DFS) were estimated using the Kaplan–Meier method. Prognostic factors associated with CSS were sought in univariate analysis. The log-rank test was used for categorical variables and the Cox model for continuous variables.

Results

110 patients were included with a median follow-up of 64.4 months [95% CI = (61.0–66.7)]. Median age was 61 years (29–83) with 62.7% of men and 37.3% of women. Median RENAL score was 6 (4–10) with elective indications accounting for 95% of cases. Out of 27 patients (24.5%) who experienced peri-operative complication, 12 patients (10.9%) had a major complication (Clavien-Dindo grade ≥ 3). The TRIFECTA achievement rate was 52.7%. Three patients (2.7%) experienced local recurrence and seven patients (6.4%) progressed to a metastatic disease. 5-year OS, CSS, DFS were 94.9, 96.8, 86.4%, respectively. In univariate analysis, no pre/peri-operative characteristic was associated with DFS. No port-site metastasis was observed and there was one case of peritoneal carcinomatosis.

Conclusion

In this multicenter series, long-term OS, DFS and CSS after RPN appeared comparable to large series of open partial nephrectomy, with no port-site metastasis and one case of peritoneal carcinomatosis.

Keywords

Partial nephrectomy Kidney neoplasm Long-term Oncology 

Notes

Author contributions

JBB: Protocol/project development, Data analysis, Manuscript writing/editing. BP: Protocol/project development, Data analysis, Manuscript writing/editing. TB: Data collection or management, Data analysis. BC: Data analysis. TS: Manuscript writing/editing. MR: Protocol/Project development. BP: Data collection or management, Data analysis. ZEK: Data collection or management, Manuscript writing/editing. QM: Data collection or management. GV: Manuscript writing/editing. MT: Manuscript writing/editing. JP: Data collection or management. ND: Manuscript writing/editing. RM: Protocol/Project development. CV: Data collection or management, Data analysis. MS: Protocol/project development, Data analysis, Manuscript writing/editing. MR: Data collection or management, Data analysis, Manuscript writing/editing. KB: Manuscript writing/editing, Protocol/project development, Data collection or management, Data analysis.

Compliance with ethical standards

Conflict of interest

Karim Bensalah, Christophe Vaessen, Nicolas Doumerc and Gregory Verhoest are proctors for Intuitive Surgical®. Other authors declare that they have no conflict of interest.

Ethical standards

All participants have given informed consent before inclusion in the present study.

References

  1. 1.
    Smittenaar CR, Petersen KA, Stewart K, Moitt N (2016) Cancer incidence and mortality projections in the UK until 2035. Br J Cancer 115:1147–1155CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Ljungberg B, Bensalah K, Canfield S et al (2015) EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 67:913–924CrossRefPubMedGoogle Scholar
  3. 3.
    Zini L, Perrotte P, Capitanio U et al (2009) Radical versus partial nephrectomy: effect on overall and noncancer mortality. Cancer 115:1465–1471CrossRefPubMedGoogle Scholar
  4. 4.
    Gill IS, Kavoussi LR, Lane BR et al (2007) Comparison of 1800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 178:41–46CrossRefPubMedGoogle Scholar
  5. 5.
    Marszalek M, Meixl H, Polajnar M, Rauchenwald M, Jeschke K, Madersbacher S (2009) Laparoscopic and open partial nephrectomy: a matched-pair comparison of 200 patients. Eur Urol 55:1171–1178CrossRefPubMedGoogle Scholar
  6. 6.
    Lane BR, Gill IS (2010) 7-year oncological outcomes after laparoscopic and open partial nephrectomy. J Urol 183:473–479CrossRefPubMedGoogle Scholar
  7. 7.
    Choi JE, You JH, Kim DK, Rha KH, Lee SH (2015) Comparison of perioperative outcomes between robotic and laparoscopic partial nephrectomy: a systematic review and meta-analysis. Eur Urol 67:891–901CrossRefPubMedGoogle Scholar
  8. 8.
    Masson-Lecomte A, Yates DR, Hupertan V et al (2013) A prospective comparison of the pathologic and surgical outcomes obtained after elective treatment of renal cell carcinoma by open or robot-assisted partial nephrectomy. Urol Oncol 31:924–929CrossRefPubMedGoogle Scholar
  9. 9.
    Khalifeh A, Autorino R, Eyraud R et al (2013) Three-year oncologic and renal functional outcomes after robot-assisted partial nephrectomy. Eur Urol 64:744–750CrossRefPubMedGoogle Scholar
  10. 10.
    Peyronnet B, Seisen T, Oger E et al (2016) Comparison of 1800 robotic and open partial nephrectomies for renal tumors. Ann Surg Oncol 23:4277–4283CrossRefPubMedGoogle Scholar
  11. 11.
    Andrade HS, Zargar H, Caputo PA et al (2016) Five-year oncologic outcomes after transperitoneal robotic partial nephrectomy for renal cell carcinoma. Eur Urol 69:1149–1154CrossRefPubMedGoogle Scholar
  12. 12.
    Kutikov A, Uzzo RG (2009) The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182:844–853CrossRefPubMedGoogle Scholar
  13. 13.
    Wolters U, Wolf T, Stutzer H, Schroder T (1996) ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth 77:217–222CrossRefPubMedGoogle Scholar
  14. 14.
    Zargar H, Allaf ME, Bhayani S et al (2015) Trifecta and optimal perioperative outcomes of robotic and laparoscopic partial nephrectomy in surgical treatment of small renal masses: a multi-institutional study. BJU Int 116:407–414CrossRefPubMedGoogle Scholar
  15. 15.
    Lopez-Beltran A, Scarpelli M, Montironi R, Kirkali Z (2006) 2004 WHO classification of the renal tumors of the adults. Eur Urol 49:798–805CrossRefPubMedGoogle Scholar
  16. 16.
    Patard JJ, Baumert H, Bensalah K et al (2013) CCAFU recommendations 2013: renal cancer. Progres en urologie: Journal de l’Association francaise d’urologie et de la Societe francaise d’urologie 23(Suppl 2):S177–S204CrossRefGoogle Scholar
  17. 17.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Kyllo RL, Tanagho YS, Kaouk JH et al (2012) Prospective multi-center study of oncologic outcomes of robot-assisted partial nephrectomy for pT1 renal cell carcinoma. BMC Urol 12:11CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Marszalek M, Carini M, Chlosta P et al (2012) Positive surgical margins after nephron-sparing surgery. Eur Urol 61:757–763CrossRefPubMedGoogle Scholar
  20. 20.
    Bernhard JC, Pantuck AJ, Wallerand H et al (2010) Predictive factors for ipsilateral recurrence after nephron-sparing surgery in renal cell carcinoma. Eur Urol 57:1080–1086CrossRefPubMedGoogle Scholar
  21. 21.
    Khalifeh A, Kaouk JH, Bhayani S et al (2013) Positive surgical margins in robot-assisted partial nephrectomy: a multi-institutional analysis of oncologic outcomes (leave no tumor behind). J Urol 190:1674–1679CrossRefPubMedGoogle Scholar
  22. 22.
    Borghesi M, Brunocilla E, Schiavina R, Martorana G (2013) Positive surgical margins after nephron-sparing surgery for renal cell carcinoma: incidence, clinical impact, and management. Clin Genitourin Cancer 11:5–9CrossRefPubMedGoogle Scholar
  23. 23.
    Bensalah K, Pantuck AJ, Rioux-Leclercq N et al (2010) Positive surgical margin appears to have negligible impact on survival of renal cell carcinomas treated by nephron-sparing surgery. Eur Urol 57:466–471CrossRefPubMedGoogle Scholar
  24. 24.
    Ristau BT, Kutikov A, Uzzo RG, Smaldone MC (2016) Active surveillance for small renal masses: when less is more. Eur Urol Focus 2(6):660–668CrossRefPubMedGoogle Scholar
  25. 25.
    Prins FM, Kerkmeijer LGW, Pronk AA et al (2017) Renal cell carcinoma: alternative nephron-sparing treatment options for small renal masses, a systematic review. J Endourol 31(10):963–975CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Jean-Baptiste Beauval
    • 1
  • Benoit Peyronnet
    • 2
  • Thibaut Benoit
    • 1
  • Bastien Cabarrou
    • 3
  • Thomas Seisen
    • 4
  • Mathieu Roumiguié
    • 1
    • 3
  • Benjamin Pradere
    • 2
  • Zine-Eddine Khene
    • 2
  • Quentin Manach
    • 4
  • Gregory Verhoest
    • 3
  • Mathieu Thoulouzan
    • 1
    • 3
  • Jerome Parra
    • 4
  • Nicolas Doumerc
    • 1
    • 2
  • Romain Mathieu
    • 3
  • Christophe Vaessen
    • 4
  • Michel Soulié
    • 1
    • 2
  • Morgan Roupret
    • 4
  • Karim Bensalah
    • 2
  1. 1.Department of UrologyCHU RangueilToulouseFrance
  2. 2.Department of UrologyCHURennesFrance
  3. 3.IUCTToulouseFrance
  4. 4.Department of UrologyLa Pitié-Salpetrière Hospital, APHPParisFrance

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