To analyze the outcomes of robot-assisted partial nephrectomy (RAPN) in patients with a solitary kidney in a large multi-institutional database.
A total of 2755 patients in the Vattikuti Collective Quality Initiative database underwent RAPN by 22 surgeons at 14 centers in nine 9 countries. Out of these patients, 74 underwent RAPN in solitary kidney between 2007 and 2016. A retrospective analysis of the functional and oncological outcomes was performed. Trifecta was defined as a warm ischemia time of less than 20 minutes, negative surgical margins, and no complications intraoperatively or within 3 months of follow up.
All 74 patients underwent RAPN successfully with one conversion to radical nephrectomy. The median (interquartile range [IQR]) operative time was 180 (142-230) minutes. Early unclamping was used in 11 (14.9%) cases, while zero ischemia was used in 12 (16.2%) cases. Trifecta outcomes were achieved in 38/66 (57.6%) of the patients. Median (IQR) ischemia time was 15.5 (8.75-20.0) minutes for the entire cohort. Overall complication rate was 24.1% and the rate of Clavien-Dindo ≤2 complications was 16.3%. Positive surgical margins were present in four cases (5.4%). Median (IQR) follow-up was 10.5 (2.12-24.0) months. The median drop in estimated glomerular filtration rate at three months was 7.0 ml/min/1.72m(2) (11.01%).
Our findings suggest that RAPN is a safe and effective treatment option for select renal tumors in solitary kidneys in terms of a trifecta of negative surgical margins, warm ischemia time less than 20 minutes, and low operative and perioperative morbidity. This article is protected by copyright. All rights reserved.
BJU international. 2017 Jul 27 [Epub ahead of print]
Sohrab Arora, Ronney Abaza, James M Adshead, Rajesh K Ahlawat, Benjamin J Challacombe, Prokar Dasgupta, Giorgio Gandaglia, Daniel A Moon, T B Yuvaraja, Umberto Capitanio, Alessandro Larcher, Francesco Porpiglia, James R Porter, Alexander Mottrie, Mahendra Bhandari, Craig Rogers
Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA., Department of Urology, Ohio Health Dublin Methodist Hospital, Dublin, OH, USA., Hertfordshire and South Bedfordshire Urological Cancer Centre, Lister Hospital, Stevenage, UK., Fortis Escorts Kidney and Urology Institute, New Delhi, India., MRC Centre for Transplantation, King's College London, London, UK., Urology Clinic, San Rafaele Hospital, Milan, Italy., Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia., Kokilaben Dhirubhai Ambani Hospital, Mumbai, India., San Raffaele Hospital, Milan, Italy., San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy., Swedish Medical Center, Seattle, WA, USA., OLV Vattikuti Robotic Surgery Institute, Melle, Belgium.