Enucleation versus enucleoresection in robotic partial nephrectomy: Real-world data from the multicenter YAU kidney...

Area of Science:

• Urology
• Minimally Invasive Surgery
• Oncology

Background:

• Robot-assisted partial nephrectomy (RAPN) is the preferred minimally invasive method for localized renal tumors.
• Parenchymal preservation is key, with enucleation emerging as a promising technique.
• This study compares enucleation and enucleoresection in RAPN.

Purpose of the Study:

• To compare perioperative and functional outcomes of enucleation versus enucleoresection in RAPN.
• To evaluate the impact of surgical technique on acute kidney injury (AKI) and chronic kidney disease (CKD) progression.
• To assess renal function trends over time after different resection techniques.

Main Methods:

• Data from a large, multicenter European Association of Urology Young Academic Urologists (EAU-YAU) database (2015-2024).
• Included patients undergoing RAPN with documented enucleation or enucleoresection.
• Primary endpoints: AKI and CKD worsening. Statistical analysis included logistic regression, Cox models, and Kaplan-Meier curves.

Main Results:

• Enucleoresection showed longer ischemia, higher complications, and lower positive margin rates (5.2% vs 8.3%).
• Postoperative AKI was more frequent after enucleoresection (18% vs 3%).
• Enucleation was linked to lower CKD progression risk, especially in patients with baseline CKD stages 1-2.

Conclusions:

• Enucleation in RAPN is a parenchyma-sparing approach with functional benefits, particularly for patients with good baseline renal function.
• The potential functional advantages of enucleation must be weighed against a slightly increased risk of positive surgical margins.
• Careful patient selection and standardized surgical techniques are crucial for optimizing outcomes in RAPN.