Surgical Experience and Functional Outcomes after Laparoscopic and Robot-Assisted Partial Nephrectomy: Results from a...

Area of Science:

• Urology
• Nephrology
• Surgical Outcomes Research

Background:

• Prior partial nephrectomy studies indicate surgical experience improves peri-operative outcomes like complications and ischemia time.
• However, data on the impact of surgeon experience on long-term functional renal outcomes after partial nephrectomy remain limited.
• This study investigates whether surgeon experience influences acute kidney injury (AKI) and long-term estimated glomerular filtration rate (eGFR) recovery.

Purpose of the Study:

• To evaluate the association between surgeon's experience and functional renal outcomes (AKI and eGFR recovery) after partial nephrectomy.
• To analyze outcomes in both laparoscopic and robot-assisted partial nephrectomy procedures.
• To determine if surgical learning curves significantly affect patient renal function post-surgery.

Main Methods:

• Retrospective analysis of 4011 patients with unilateral cT1a-b renal masses undergoing partial nephrectomy (laparoscopic or robot-assisted).
• Data collected from 119 surgeons across 22 institutions between 1997 and 2022.
• Multivariable models assessed the link between prior operations (surgical experience) and AKI/eGFR recovery, adjusting for patient and tumor characteristics.

Main Results:

• No significant association was found between surgical experience and AKI or 1-year eGFR recovery in either laparoscopic or robot-assisted partial nephrectomy.
• Laparoscopic partial nephrectomy: 8% AKI, 55% eGFR recovery; Robot-assisted: 11% AKI, 54% eGFR recovery.
• Odds ratios for AKI and eGFR recovery showed no statistically significant relationship with increasing surgeon experience in either approach.

Conclusions:

• Surgeon experience may not be a critical factor for achieving optimal functional recovery after partial nephrectomy.
• Findings challenge the reliance on serum markers for assessing functional recovery in patients with two kidneys.
• Further research is needed to identify specific procedural elements contributing to consistent, high-quality outcomes regardless of surgeon experience.