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An International Delphi Consensus About Tumor Rupture During Robotic Partial Nephrectomy (Researching UnPredictable

Riccardo Bertolo1, Alessandro Antonelli1, Axel Bex2,3

  • 1Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Borgo Trento Hospital, Verona, Italy.

European Urology Open Science
|October 3, 2025
PubMed
Summary
This summary is machine-generated.

Tumor rupture during robotic partial nephrectomy (RAPN) is a rare risk. This consensus study defined rupture, identified risk factors like tumor size, and recommended management to minimize spillage, though oncological impact varies.

Keywords:
DelphiNephrectomyRenal neoplasmRupture

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Area of Science:

  • Urology
  • Oncology
  • Surgical Innovation

Background:

  • Tumor rupture during robot-assisted partial nephrectomy (RAPN) presents oncological risks, including potential malignant cell spread and recurrence.
  • Standardized guidelines for managing tumor rupture in RAPN are currently lacking.
  • This study addresses the need for consensus on definition, risk factors, and management strategies for tumor rupture during RAPN.

Purpose of the Study:

  • To establish a consensus definition for tumor rupture in RAPN.
  • To identify key risk factors associated with tumor rupture during RAPN.
  • To propose standardized management strategies for tumor rupture to mitigate oncological risks.

Main Methods:

  • A modified Delphi method was employed, adhering to the ACcurate COnsensus Reporting Document (ACCORD) checklist.
  • A panel of 33 international urological experts participated in a two-phase Delphi survey.
  • Consensus was defined as ≥70% agreement, with unresolved issues addressed in an online meeting and subsequent voting rounds.

Main Results:

  • Consensus was achieved on definitions and management strategies for tumor rupture in RAPN.
  • Identified risk factors include larger tumor size, complexity, and endophytic growth patterns.
  • Recommended management involves suctioning rather than grasping cancerous tissue and using an endobag; routine conversion to radical nephrectomy is not advised unless unresectable remnants are present.
  • Tumor rupture was not definitively linked to distant metastasis, but its oncological impact depends on rupture extent.

Conclusions:

  • This Delphi consensus provides a foundational framework for understanding and managing tumor rupture in RAPN.
  • Standardized definitions and uniform management strategies are crucial for future research and clinical practice.
  • Empirical validation through prospective clinical studies is warranted to further refine management and assess long-term oncological outcomes.