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Robot-assisted laparoscopic nephron sparing surgery for tumors over 4 cm: operative results and preliminary oncologic
A Masson-Lecomte1, D R Yates, K Bensalah
1Department of Urology, CHU Pitié Salpétrière, Assistance Publique Hopitaux de Paris, Paris, France.
Objective:
To assess operative and pathological results obtained after robot-assisted partial nephrectomy (RAPN) in renal masses over 4 cm.
Patients And Methods:
Between 2007 and 2011, 220 robotic nephron-sparing surgeries (NSS) were performed at six French urology departments. Data were prospectively collected: age, BMI, pre and post-operative eGFR (MDRD), operative time (OT), warm ischemia time (WIT), estimated blood loss (EBL), length of hospital stay (LOS), Clavien complications, pathological results and oncologic outcome. Tumor complexity was assessed according to the RENAL nephrometry score.
Results:
Overall, 54 tumors were included. Median follow up was 26 months. Median age at surgery was 62 years. Median RENAL nephrometry score was 7 (4-10). Median WIT was 23 min (10-59). Median OT and EBL were 180 min (110-425) and 100 cc (0-2500). Blood transfusion occurred in 7 cases (13%). Median tumor size was 45 mm (40-70). Three patients had positive surgical margins. Median LOS was 5 days (2-28). Nine patients presented post-operative complications of which 1/3 were considered as major (Clavien IIIb). Median pre-operative and post-operative eGFR was 88 (36-136) and 75 ml/min (33-122) (p = 0.01), respectively. Two patients developed subsequent metastasis. The 2-year progression free survival (PFS) rate was 90.5%.
Conclusion:
Our results confirm that RAPN is a useful and acceptable approach for renal masses greater than 4 cm in size. When technically possible, NSS provides promising short-term cancer-specific survival rates with acceptable morbidity. Tumor size is not sufficiently discriminant enough and RENAL nephrometry score should increasingly used to describe tumor complexity.
Insights
Robot-assisted partial nephrectomy (RAPN) is a viable option for larger renal masses (>4 cm), offering acceptable outcomes and promising survival rates. This nephron-sparing surgery (NSS) approach demonstrates good oncologic control with manageable complications.
Area of Science:
- Urology
- Surgical Oncology
- Robotic Surgery
Background:
- Robot-assisted partial nephrectomy (RAPN) is increasingly used for renal tumors.
- Assessing outcomes for larger renal masses (>4 cm) is crucial.
Purpose of the Study:
- To evaluate the operative and pathological results of RAPN for renal masses exceeding 4 cm.
- To determine the safety and efficacy of RAPN in this patient cohort.
Main Methods:
- Prospective data collection from 220 RAPN procedures across six French urology departments (2007-2011).
- Analysis included operative time, ischemia time, blood loss, complications, pathological findings, and oncologic outcomes.
- Tumor complexity was assessed using the RENAL nephrometry score.
Main Results:
- 54 tumors >4 cm were analyzed with a median follow-up of 26 months.
- Median operative time: 180 min, warm ischemia time: 23 min, estimated blood loss: 100 cc.
- Post-operative complications occurred in 9 patients (16.7%), with 1/3 considered major (Clavien IIIb).
- Median eGFR decreased from 88 to 75 ml/min (p=0.01).
- Two-year progression-free survival rate was 90.5% with only two subsequent metastases.
Conclusions:
- RAPN is a safe and effective approach for managing renal masses larger than 4 cm.
- Nephron-sparing surgery (NSS) offers promising short-term oncologic outcomes with acceptable morbidity.
- RENAL nephrometry score is valuable for describing tumor complexity, more so than tumor size alone.
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