Achieving tumour control when suspecting sinus fat involvement during robot-assisted partial nephrectomy:...

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Robot-assisted partial nephrectomy (RAPN) is increasingly used for renal tumors.
• Managing T3 renal tumors involving sinus fat presents surgical challenges for local cancer control.
• The R.E.N.A.L. nephrometry score aids in stratifying tumor complexity.

Purpose of the Study:

• To describe a single expert surgeon's technique for RAPN in T3 renal tumors.
• To evaluate the efficacy of this technique in achieving local cancer control.
• To assess oncological outcomes, including surgical margins and recurrence, in a selected patient cohort.

Main Methods:

• A retrospective analysis of patients undergoing transperitoneal RAPN for pT3a renal tumors involving sinus fat was performed.
• Tumors were selected based on a preoperative R.E.N.A.L. nephrometry score of 3 for the 'N' (Nearness) item.
• Surgical technique details and perioperative/oncological outcomes were extracted from an institutional database.

Main Results:

• The study analyzed 24 patients with pT3a tumors involving sinus fat, selected via R.E.N.A.L. nephrometry.
• The described RAPN technique resulted in no positive surgical margins (PSMs).
• Trifecta achievement was 54.2%, with low rates of recurrence (2 patients) and metastasis (1 patient) at a median 30-month follow-up.

Conclusions:

• The presented RAPN technique effectively achieves local cancer control for selected pT3a renal tumors involving sinus fat.
• This approach demonstrates favorable oncological outcomes in patients with complex renal masses.
• The study highlights the importance of meticulous surgical technique in robotic partial nephrectomy for advanced renal tumors.