Multiple Tumor Excisions in Ipsilateral Kidney Increase Complications After Partial Nephrectomy

Area of Science:

• Urology
• Surgical Oncology
• Nephrology

Background:

• Ipsilateral synchronous multifocality (ISM) describes multiple renal masses in the same kidney.
• The surgical morbidity associated with ISM during robotic partial nephrectomy (RPN) is not well understood.
• Assessing the impact of ISM on postoperative complications is crucial for patient management.

Purpose of the Study:

• To evaluate the association between ISM and postoperative complications after RPN.
• To determine if the number of renal mass excisions impacts complication rates.
• To identify predictors of complications in RPN for multifocal renal masses.

Main Methods:

• Retrospective review of 1121 RPN cases performed between 2006 and 2015.
• Multifocal disease defined by preoperative imaging or multiple intraoperative excisions.
• Complication rates analyzed using univariate and multivariable logistic regression.

Main Results:

• Of 1121 cases, 5.3% had multifocal disease on imaging and 4.5% required multiple excisions.
• The number of excisions, not radiographic multifocality, significantly predicted postoperative complications (OR 3.1, p=0.041).
• Complications included transfusion, urine leak, arrhythmia, venous thromboembolism, and ileus, with higher rates for >2 excisions.

Conclusions:

• Robotic partial nephrectomy requiring two or more excisions for multifocal renal masses is linked to increased surgical morbidity.
• Preoperative identification of multifocal disease and the anticipated number of excisions can aid in clinical decision-making and patient counseling.
• Further external validation is recommended to confirm these findings.