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Robot-assisted partial nephrectomy in morbidly obese patients: a VCQI database study.

Gopal Sharma1, Gurpremjit Singh2, Puneet Ahluwalia2

  • 1Department of Urologic Oncology, Medanta The Medicity, Gurgaon, India. gopal.26669192@gmail.com.

Journal of Robotic Surgery
|May 29, 2023
PubMed

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External validation of the preoperative risk evaluation for partial nephrectomy (PREP) score.

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Summary
This summary is machine-generated.

Robot-assisted partial nephrectomy (RAPN) offers comparable perioperative outcomes for morbidly obese patients (BMI > 40 kg/m²) and non-obese individuals. This study found similar trifecta results and complication rates, demonstrating RAPN

Area of Science:

  • Urology
  • Surgical Oncology
  • Nephrology

Background:

  • Morbid obesity (BMI > 40 kg/m²) presents unique challenges in minimally invasive surgery.
  • Robot-assisted partial nephrectomy (RAPN) is increasingly used for kidney tumor treatment.
  • Outcomes of RAPN in morbidly obese patients require further investigation.

Purpose of the Study:

  • To compare perioperative outcomes of RAPN between morbidly obese and non-obese patients.
  • To evaluate trifecta outcomes (negative margins, no positive margins, and术后肾功能保留) in both groups.
  • To assess complications and functional renal outcomes after RAPN in obese versus non-obese populations.

Main Methods:

  • Utilized the Vattikuti Collective quality initiative (VCQI) database for RAPN cases.
Keywords:
Morbid obesityPartial nephrectomyPropensity-matchingRobotic

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  • Matched 158 morbidly obese patients with 158 non-obese patients using propensity scores.
  • Key variables for matching included age, sex, tumor size, renal function (eGFR), and surgical approach.

    • Main Results:

    • No significant differences were observed in ischemia time, blood loss, transfusion rates, conversion to radical nephrectomy, or length of stay.
    • Operative time was longer in the morbidly obese group (210 min vs. 120 min).
    • Malignant tumors were more frequent in the morbidly obese group (83.1% vs. 73.4%).
    • Trifecta outcomes were comparable (60.1% vs. 63.3%).
    • While day one creatinine was higher and eGFR lower in obese patients, long-term renal function (creatinine and eGFR at last follow-up) was similar between groups.

    Conclusions:

    • RAPN in morbidly obese patients is associated with equivalent perioperative and functional renal outcomes compared to non-obese patients.
    • Despite longer operative times, RAPN is a safe and effective option for kidney tumor management in the morbidly obese population.
    • The study supports the use of RAPN for selected morbidly obese patients undergoing partial nephrectomy.