'Trifecta' outcomes of robot-assisted partial nephrectomy in solitary kidney: a Vattikuti Collective Quality Initiative (VCQI) database analysis. in BJU international / BJU Int. 2018 Jan;121(1):119-123. doi: 10.1111/bju.13967. Epub 2017 Aug 16.
2018
AOU San Luigi di Orbassano
Tipo pubblicazione
Multicenter Study
Autori/Collaboratori (16)Vedi tutti...
Arora S
Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
Abaza R
Department of Urology, Ohio Health Dublin Methodist Hospital, Dublin, OH, USA.
Adshead JM
Hertfordshire and South Bedfordshire Urological Cancer Centre, Lister Hospital, Stevenage, UK.
et alii...
Abstract
OBJECTIVES: To analyse the outcomes of robot-assisted partial nephrectomy (RAPN) in patients with a solitary kidney in a large multi-institutional database. PATIENTS AND METHODS: In all, 2755 patients in the Vattikuti Collective Quality Initiative database underwent RAPN by 22 surgeons at 14 centres in nine countries. Of these patients, 74 underwent RAPN with a solitary kidney between 2007 and 2016. We retrospectively analysed the functional and oncological outcomes of these 74 patients. A 'trifecta' of outcomes was assessed, with trifecta defined as a warm ischaemia time (WIT) of <20 min, negative surgical margins, and no complications intraoperatively or within 3 months of RAPN. RESULTS: All 74 patients underwent RAPN successfully with one conversion to radical nephrectomy. The median (interquartile range [IQR]) operative time was 180 (142-230) min. Early unclamping was used in 11 (14.9%) patients and zero ischaemia was used in 12 (16.2%). Trifecta outcomes were achieved in 38 of 66 patients (57.6%). The median (IQR) WIT was 15.5 (8.75-20.0) min for the entire cohort. The overall complication rate was 24.1% and the rate of Clavien-Dindo grade ?II complications was 16.3%. Positive surgical margins were present in four cases (5.4%). The median (IQR) follow-up was 10.5 (2.12-24.0) months. The median drop in estimated glomerular filtration rate at 3 months was 7.0 mL/min/1.72 m(2) (11.01%). CONCLUSION: Our findings suggest that RAPN is a safe and effective treatment option for select renal tumours in solitary kidneys in terms of a trifecta of negative surgical margins, WIT of <20 min, and low operative and perioperative morbidity.
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PMID : 28749068
DOI : 10.1111/bju.13967
Keywords
Robotic Surgical Procedures/adverse effects/methods; Retrospective Studies; Retroperitoneal Space; Postoperative Complications/epidemiology/physiopathology; Patient Safety; Outcome Assessment, Health Care; Operative Time; Nephrectomy/adverse effects/methods; Middle Aged; Margins of Excision; Male; Kidney Neoplasms/mortality/pathology/surgery; Internationality; Humans; Glomerular Filtration Rate/physiology; Female; Disease-Free Survival; Databases, Factual; Cohort Studies; Aged; Solitary Kidney/surgery; Survival Analysis; nephron-sparing surgery; robot-assisted partial nephrectomy; robotic partial nephrectomy; robotic surgery; solitary kidney;