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Uemura K, Ito H, Ikeda M, Uehara K, Tatenuma T, Komeya M, Ito Y, Muraoka K, Hasumi H, Makiyama K. Predictive factors for pentafecta achievement in robot-assisted partial nephrectomy for intermediate highly complex RENAL tumors (RENAL score ≥ 7). Int J Urol 2023; 30:1096-1102. [PMID: 37592739 DOI: 10.1111/iju.15274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/30/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVES To investigate the predictive factors for pentafecta achievement of robot-assisted partial nephrectomy (RAPN) for intermediate highly complex renal tumors (RENAL score ≥ 7). METHODS We retrospectively analyzed the data of 247 patients with renal tumors with a RENAL score ≥ 7 who underwent RAPN. Baseline characteristics and perioperative outcomes were compared between the pentafecta achieved group and the unachieved group. A multivariable logistic regression model was used to identify the predictive factors for pentafecta achievement for cT1 renal tumors with a RENAL score ≥ 7. RESULTS Of the 247 patients, 75 (30.3%) patients were in the achieved group and 172 (69.7%) patients were in the unachieved group. The median warm ischemia time and total operation time were 18 min versus 23 min (p < 0.001) and 179 min versus 201 min (p < 0.001) in the achieved and unachieved groups, respectively. In the unachieved group, six patients (3.4%) had major perioperative complications (Clavien-Dindo classification system ≥3). The median preservation rates of estimated GFR at the 1-year postoperative period were 96.5% versus 83.0% (p < 0.001) in the achieved and unachieved groups. Multivariable logistic regression models revealed that age and tumor size were independent predictive factors for pentafecta achievement for cT1 renal tumors with a RENAL score ≥ 7. There were no significant differences in cancer-free survival between the two groups (p = 0.456). CONCLUSION Age and tumor size were independent predictive factors for pentafecta achievement, although there was no difference in oncological outcomes between the pentafecta achieved group and the unachieved group in RAPN for cT1 renal tumors with a RENAL score ≥ 7.
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Affiliation(s)
- Koichi Uemura
- Department of Urology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Hiroki Ito
- Department of Urology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Maiko Ikeda
- Department of Urology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Koichiro Uehara
- Department of Urology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Tomoyuki Tatenuma
- Department of Urology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Mitsuru Komeya
- Department of Urology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Yusuke Ito
- Department of Urology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Kentaro Muraoka
- Department of Urology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Hisashi Hasumi
- Department of Urology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Kazuhide Makiyama
- Department of Urology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
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Lee CU, Alabbasi M, Chung JH, Kang M, Seo SI. How far has robot-assisted partial nephrectomy reached? Investig Clin Urol 2023; 64:435-447. [PMID: 37668199 PMCID: PMC10482664 DOI: 10.4111/icu.20230121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/07/2023] [Accepted: 07/06/2023] [Indexed: 09/06/2023] Open
Abstract
Nephron-sparing surgery is the standard treatment for small renal mass (SRM). Nephron-sparing surgery has evolved from an open to a minimally invasive technique. Robot-assisted partial nephrectomy (RAPN) is the latest technique in this field and is reported to be safe and feasible, showing oncologically and functionally superior or compatible results compared with open and laparoscopic partial nephrectomy for SRM. This is not limited to only SRM but also applies to large and complex renal masses and other challenging situations. RAPN showed good oncological and functional outcomes for ≥clinical T2 renal tumors, complex renal masses (PADUA score ≥10, RENAL score ≥10), hilar renal tumors, and multiple renal tumors. In addition, the outcomes of RAPN in these challenging cases were not inferior to those in conventional cases. RAPN could also be applied to a number of challenging cases in which the open technique was considered first. RAPN showed good results in patients with a solitary kidney, horseshoe kidney, and in repeat surgeries. Furthermore, RAPN could be safely performed on obese, elderly, and pediatric patients. Finally, this review evaluates efficiency and utility of RAPN based on the results of challenging cases of renal masses and to project the future of RAPN.
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Affiliation(s)
- Chung Un Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mahmood Alabbasi
- Bahrain Defence Force Royal Medical Services, Riffa, Southern, Bahrain
| | - Jae Hoon Chung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Minyong Kang
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Ucpinar B, Rich JM, Okhawere KE, Razdan S, Zaytoun O, Zuluaga L, Saini I, Stifelman MD, Abaza R, Eun DD, Bhandari A, Hemal AK, Porter J, Crivellero S, Mansour A, Pierorazio PM, Badani KK. Robot-assisted partial nephrectomy for complex renal tumors: Analysis of a large multi-institutional database. Urol Oncol 2023:S1078-1439(23)00189-8. [PMID: 37316415 DOI: 10.1016/j.urolonc.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 03/25/2023] [Accepted: 05/18/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Highly complex renal masses pose a challenge to urologic surgeons' ability to perform robotic partial nephrectomy (RPN). Given the increased utilization of the robotic approach for small renal masses, we sought to characterize the outcomes and determine the safety and feasibility of RPN for complex renal masses from our large multi-institutional cohort. METHODS We performed a retrospective analysis of patients with R.E.N.A.L. Nephrometry Scores ≥10 who underwent RPN in our multi-institutional cohort (N = 372). Baseline demographic, clinical and tumor related characteristics were evaluated with the primary endpoint of trifecta achievement (defined as negative surgical margin, no major complications, and warm ischemia time ≤25 min). Relationships between variables were assessed using the chi-square test of independence, Fisher exact test, Mann-Whitney U test, and Kruskal Wallis test. Logistic regression was used to evaluate the relationship between baseline characteristics and trifecta achievement. RESULTS Of 372 patients in the study, mean age was 58 years, and median BMI was 30.49 kg/m2. The median tumor size was 4.3 cm (3.0-5.9 cm). Most of the patients had R.E.N.A.L. scores of 10 (n = 253; 67.01%). Overall, trifecta was achieved in 72.04% of patients. Stratifying intraoperative and postoperative outcomes by R.E.N.A.L. scores, there was no significant difference in trifecta achievement, operative time, warm ischemia time (WIT), open conversion, major complication, or positive margin rates. Length of hospital stay was significantly longer for higher R.E.N.A.L. scores (median days 2 vs. 1, P = 0.012). Multivariate analyses for factors associated with trifecta achievement concluded that age and baseline eGFR were independently associated with trifecta achievement. CONCLUSION RPN is a safe and reproducible procedure for complex tumors with R.E.N.A.L. Nephrometry scores ≥10. Our results suggest excellent rates of trifecta achievement and short-term functional outcomes when performed by experienced surgeons. Long-term oncological and functional evaluation are needed to further support this conclusion.
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Affiliation(s)
- Burak Ucpinar
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Jordan Miller Rich
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kennedy E Okhawere
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shirin Razdan
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Osama Zaytoun
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Laura Zuluaga
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Indu Saini
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Ronney Abaza
- Department of Urology, Central Ohio Urology Group, Columbus, OH
| | - Daniel D Eun
- Department of Urology, Lewis Katz School of Medicine Temple University, Philadelphia, PA
| | - Akshay Bhandari
- Division of Urology, Mount Sinai Medical Center, Miami Beach, FL
| | - Ashok K Hemal
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC
| | - James Porter
- Department of Urology, Swedish Urology, Seattle, WA
| | | | - Ahmed Mansour
- Department of Urology, University of Texas Health Science Center, San Antonio, TX
| | | | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
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Li KP, Chen SY, Wang CY, Yang L. Comparison between minimally invasive partial nephrectomy and open partial nephrectomy for complex renal tumors: a systematic review and meta-analysis. Int J Surg 2023; 109:1769-1782. [PMID: 37094827 PMCID: PMC10389432 DOI: 10.1097/js9.0000000000000397] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/04/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND The present study aimed to conduct a pooled analysis to compare the efficacy and safety of minimally invasive partial nephrectomy (MIPN) with open partial nephrectomy (OPN) in patients with complex renal tumors (defined as PADUA or RENAL score ≥7). METHODS The present study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, Supplemental Digital Content 1, http://links.lww.com/JS9/A394 . We conducted a systematic search of the PubMed, Embase, Web of Science, and Cochrane Library databases until October 2022. MIPN and OPN-controlled trials for complex renal tumors were included. The primary outcomes were perioperative results, complications, renal function, and oncologic outcomes. RESULTS A total of 2405 patients were included in 13 studies. MIPN outperformed OPN in terms of hospital stay [weighted mean difference (WMD) -1.84 days, 95% CI -2.35 to -1.33; P <0.00001], blood loss (WMD -52.42 ml, 95% CI -71.43 to -33.41; P <0.00001), transfusion rates [odds ratio (OR) 0.34, 95% CI 0.17-0.67; P =0.002], major complications (OR 0.59, 95% CI 0.40-0.86; P =0.007) and overall complications (OR 0.43, 95% CI 0.31-0.59; P <0.0001), while operative time, warm ischemia time, conversion to radical nephrectomy rates, estimated glomerular decline, positive surgical margins, local recurrence, overall survival, recurrence-free survival, and cancer-specific survival were not significantly different. CONCLUSIONS The present study demonstrated that MIPN was associated with a shorter length of hospital stay, less blood loss, and fewer complications in treating complex renal tumors. MIPN may be considered a better treatment for patients with complex tumors when technically feasible.
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Affiliation(s)
| | | | | | - Li Yang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, People’s Republic of China
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5
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Razdan S, Okhawere KE, Ucpinar B, Saini I, Deluxe A, Abaza R, Eun DD, Bhandari A, Hemal AK, Porter J, Stifelman MD, Crivellaro S, Pierorazio PM, Badani KK. The State of Robotic Partial Nephrectomy: Operative, Functional, and Oncological Outcomes From A Robust Multi-Institution Collaborative. Urology 2023; 173:92-97. [PMID: 36592701 DOI: 10.1016/j.urology.2022.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/18/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To describe the most recent surgical, functional, and oncological outcomes of RPN utilizing one of the largest, prospectively maintained, multi-institution consortium of patients undergoing robotic renal surgery. MATERIALS AND METHODS Data was obtained from a prospectively maintained multi-institutional database of patients who underwent RPN for clinically localized kidney cancer between 2018 and 2022 by 9 high-volume surgeons. Demographic and tumor characteristics as well as operative, functional, and oncological outcomes were queried. RESULTS A total of 2836 patients underwent RPN. Intraoperative, postoperative, and 30-day major complication rates were 2.68%, 11.39%, and 3.24%, respectively. Median tumor size was 3.0 cm. Tumors with low complexity had a shorter median operative time, lower median EBL, shorter median ischemia time, lower postoperative complication rate, and lower decline in renal function There was no significant difference between tumor complexities with respect to the rate of conversion to radical nephrectomy, conversion to open, major complications, and positive margins. Lower BMI, smaller clinical tumor size, lower tumor complexity, and higher baseline eGFR were significantly associated with trifecta achievement. CONCLUSION Patient BMI, baseline eGFR, and tumor characteristics such as size and complexity are the most important predictors of trifecta achievement. Patients with complex tumors should be counseled that they are at increased risk of complications and worsening renal function after robotic partial nephrectomy.
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Affiliation(s)
- Shirin Razdan
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Kennedy E Okhawere
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Burak Ucpinar
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Indu Saini
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Antony Deluxe
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ronney Abaza
- Central Ohio Urology Group and Mount Carmel Health System Prostate Cancer Program, Columbus, OH
| | - Daniel D Eun
- Department of Urology, Lewis Katz School of Medicine Temple University, Philadelphia, PA
| | - Akshay Bhandari
- Division of Urology, Mount Sinai Medical Center, Miami Beach, FL
| | - Ashok K Hemal
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC
| | - James Porter
- Department of Urology, Swedish Urology, Seattle, WA
| | | | | | | | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
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6
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Dautzenberg L, Pals JEM, Lefeber GJ, Stella PR, Abawi M, Emmelot-Vonk M, Koek HL. Predictors of clinical outcome following transcatheter aortic valve implantation: a prospective cohort study. Open Heart 2021; 8:openhrt-2021-001766. [PMID: 34556561 PMCID: PMC8461740 DOI: 10.1136/openhrt-2021-001766] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/03/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE In recent years, transcatheter aortic valve implantation (TAVI) has become the treatment of choice for patients with symptomatic aortic valve stenosis considered to be at increased or high surgical risk. The aim of this study was to identify predictors of postoperative adverse events in older adults undergoing TAVI. METHODS A prospective observational cohort study of patients who were referred to a geriatric outpatient clinic for a geriatric assessment prior to TAVI was conducted. The outcomes were mortality and hospital readmission within 3 months of TAVI and the occurrence of major postoperative complications during hospitalisation according to the Clavien-Dindo classification. These three outcomes were also combined to a composite outcome. Univariate and multivariate logistic regression analyses were performed to identify predictors of the outcomes and composite outcome of adverse events. RESULTS This cohort included 490 patients who underwent TAVI (mean age 80.7±6.2 years, 47.3% male). Within 3 months of TAVI, 19 (3.9%) patients died and 46 (9.4%) patients experienced a hospital readmission. A total of 177 (36.1%) patients experienced one or more major complications according to the Clavien-Dindo classification during hospitalisation and 193 patients (39.4%) experienced the composite outcome of adverse events. In multivariate analyses, cognitive impairment was identified as an independent predictor of major postoperative complications (OR 2.16; 95% CI 1.14 to 4.19) and the composite outcome of adverse events (OR 2.40; 95% CI 1.21 to 4.79). No association was found between the other variables and the separate outcomes and composite outcome. CONCLUSION Cognitive impairment is associated with postoperative adverse events in older patients undergoing TAVI. Therefore, it is important to screen for cognitive impairment prior to TAVI and it is recommended to include this in current TAVI guidelines.
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Affiliation(s)
- Lauren Dautzenberg
- Department of Geriatric Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Judith E M Pals
- Department of Geriatric Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Geert J Lefeber
- Department of Geriatric Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Pieter R Stella
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Masieh Abawi
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Marielle Emmelot-Vonk
- Department of Geriatric Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Huiberdina L Koek
- Department of Geriatric Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
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