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1
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Bertolo R, Amparore D, Muselaers S, Marchioni M, Wu Z, Campi R, Antonelli A. Thermal ablation for T1b renal cancer: an "I wish I could, but I cannot?". Minerva Urol Nephrol 2024; 76:254-259. [PMID: 38742559 DOI: 10.23736/s2724-6051.24.05842-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Affiliation(s)
- Riccardo Bertolo
- Unit of Urology, Confortini Surgical Center, Civile Maggiore Hospital, University Hospital of Verona, University of Verona, Verona, Italy -
- EAU Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands -
| | - Daniele Amparore
- EAU Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Stijn Muselaers
- EAU Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Michele Marchioni
- EAU Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands
- Department of Urology, SS Annunziata Hospital, G. D'Annunzio Chieti-Pescara University, Chieti, Italy
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, G. D'Annunzio Chieti-Pescara University, Chieti, Italy
| | - Zhenjie Wu
- EAU Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands
- Department of Urology, Shanghai Hospital, Naval Medical University, Shanghai, China
| | - Riccardo Campi
- EAU Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessandro Antonelli
- Unit of Urology, Confortini Surgical Center, Civile Maggiore Hospital, University Hospital of Verona, University of Verona, Verona, Italy
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Nguyen HN, Yamada A, Naka S, Mukaisho KI, Tani T. Comparison of off-clamp microwave scissors-based sutureless partial nephrectomy versus on-clamp conventional partial nephrectomy in a canine model. Front Surg 2023; 10:1255929. [PMID: 37795145 PMCID: PMC10546044 DOI: 10.3389/fsurg.2023.1255929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/05/2023] [Indexed: 10/06/2023] Open
Abstract
Objectives To compare the usefulness and safety of off-clamp microwave scissors-based sutureless partial nephrectomy (MSPN) with on-clamp conventional partial nephrectomy (cPN) in dogs. Methods We performed off-clamp MSPN using microwave scissors (MWS) in six dogs, and on-clamp cPN in three dogs, in two-stage experiments. The bilateral kidney upper poles were resected via a midline incision under general anesthesia. After 14 days of follow-up, the lower pole resections were performed. The renal calyces exposed during renal resections were sealed and transected using MWS in off-clamp MSPN and were sutured in on-clamp cPN. In the off-clamp MSPN group, the generator's power output of MWS was set as either 50 W or 60 W for each kidney side. We compared the procedure time (PT), ischemic time (IT), blood loss (BL), and normal nephron loss (NNL) between the two techniques using the Mann-Whitney U-test. Results We successfully performed 24 off-clamp MSPNs and 12 on-clamp cPNs. The off-clamp MSPN was significantly superior to on-clamp cPN in avoiding renal ischemia (median IT, 0 min vs. 8.6 min, p < 0.001) and reducing PT (median PT, 5.8 min vs. 11.5 min, p < 0.001) and NNL (median NNL, 5.3 mm vs. 6.0 mm, p = 0.006) with comparable BL (median BL, 20.9 ml vs. 23.2 ml, p = 0.804). No bleeding and major urine leakage were noted during the reoperations. Conclusions Off-clamp MSPN outperforms on-clamp cPN in lowering the risks of postoperative renal function impairment in dogs.
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Affiliation(s)
- Ha Ngoc Nguyen
- Department of Advanced Medical Research and Development, Shiga University of Medical Science, Shiga, Japan
- Department of Urology, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Atsushi Yamada
- Medical Innovation Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Shigeyuki Naka
- Department of Advanced Medical Research and Development, Shiga University of Medical Science, Shiga, Japan
- Department of Surgery, Hino Memorial Hospital, Shiga, Japan
| | - Ken-Ichi Mukaisho
- Division of Pathology, Shiga University of Medical Science, Shiga, Japan
| | - Tohru Tani
- Department of Advanced Medical Research and Development, Shiga University of Medical Science, Shiga, Japan
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Prata F, Raso G, Ragusa A, Iannuzzi A, Tedesco F, Cacciatore L, Civitella A, Tuzzolo P, D’Addurno G, Callè P, Basile S, Fantozzi M, Pira M, Prata SM, Anceschi U, Simone G, Scarpa RM, Papalia R. Robot-Assisted Renal Surgery with the New Hugo Ras System: Trocar Placement and Docking Settings. J Pers Med 2023; 13:1372. [PMID: 37763140 PMCID: PMC10532520 DOI: 10.3390/jpm13091372] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
The current literature relating to the novel HugoTM RAS System lacks consistent data concerning the bedside features of robot-assisted partial nephrectomy (RAPN). To describe the trocar placement and docking settings for RAPN with a three-arm configuration to streamline the procedure with HugoTM RAS, between October 2022 and April 2023, twenty-five consecutive off-clamp RAPNs for renal tumors with the HugoTM RAS System were performed. We conceived a trouble-free three-arm setting to ease and standardize RAPN trocar placement and docking settings with HugoTM RAS. Perioperative data were collected. Post-operative complications were reported according to the Clavien-Dindo classification. The eGFR was calculated according to the CKD-EPI formula. Continuous variables were presented as the median and IQR, while frequencies were reported as categorical variables. Off-clamp RAPNs were successfully performed in all cases without the need for conversion or additional port placement. The median age and BMI were 69 years (IQR, 60-73) and 27.3 kg/m2 (IQR, 25.7-28.1), respectively. The median tumor size and R.E.N.A.L. score were 32.5 mm (IQR, 26-43.7) and 6 (IQR, 5-7), respectively. Two patients were affected by cT2 renal tumors. The median docking and console time were 5 (IQR, 5-6) and 90 min (IQR, 68-135.75 min), respectively, with slightly progressive improvements in the docking time achieved. No intraoperative complications occurred alongside clashes between instruments or with the bed assistant. In experienced hands, this simplified three-instrument configuration of the HugoTM RAS System for off-clamp RAPN resulted in feasible and safe practice, providing patient-tailored trocar placement and docking with non-inferior peri-perioperative outcomes to other robotic platforms.
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Affiliation(s)
- Francesco Prata
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Gianluigi Raso
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Alberto Ragusa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Andrea Iannuzzi
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Francesco Tedesco
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Loris Cacciatore
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Angelo Civitella
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Piergiorgio Tuzzolo
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Giuseppe D’Addurno
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Pasquale Callè
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Salvatore Basile
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Marco Fantozzi
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Matteo Pira
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Salvatore Mario Prata
- Simple Operating Unit of Lower Urinary Tract Surgery, SS. Trinità Hospital, Sora, 03039 Frosinone, Italy;
| | - Umberto Anceschi
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (U.A.); (G.S.)
| | - Giuseppe Simone
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (U.A.); (G.S.)
| | - Roberto Mario Scarpa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Rocco Papalia
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
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Wu Z, Amparore D, Campi R, Erdem S, Bertolo R. Prevention of the "cheese-cutter effect" during renorrhaphy after partial nephrectomy: by modifying available techniques or by just omitting cortical renorrhaphy? Minerva Urol Nephrol 2023; 75:410-412. [PMID: 37221832 DOI: 10.23736/s2724-6051.23.05366-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Zhenjie Wu
- Department of Urology, Shanghai Hospital, Naval Medical University, Shanghai, China
| | - Daniele Amparore
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Selcuk Erdem
- Division of Urologic Oncology, Department of Urology, Faculty of Medicine, Istanbul University, Istanbul, Türkiye
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Turri F, Piramide F, Dell'oglio P, de Groote R, Lambert E, di Maida F, Knipper S, Wuernschimmel C, Andras I, Liakos N, Larcher A, Rocco B, Sighinolfi C. Comment on: "Techniques and outcomes of robot-assisted partial nephrectomy for the treatment of multiple ipsilateral renal masses". Minerva Urol Nephrol 2023; 75:398-400. [PMID: 37221828 DOI: 10.23736/s2724-6051.23.05353-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Filippo Turri
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Federico Piramide
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy -
| | - Paolo Dell'oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Ruben de Groote
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Edward Lambert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Fabrizio di Maida
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Sophie Knipper
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Iulia Andras
- Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Nikolaos Liakos
- Department of Urology, St. Antonius Hospital Gronau, Gronau, Germany
| | - Alessandro Larcher
- Division of Experimental Oncology, Department of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Bernardo Rocco
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Chiara Sighinolfi
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
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Amparore D, Piramide F, Verri P, Checcucci E, De Cillis S, Piana A, Volpi G, Burgio M, Busacca G, Colombo M, Fiori C, Porpiglia F. New Generation of 3D Virtual Models with Perfusional Zones: Perioperative Assistance for the Best Pedicle Management during Robotic Partial Nephrectomy. Curr Oncol 2023; 30:4021-4032. [PMID: 37185417 PMCID: PMC10136700 DOI: 10.3390/curroncol30040304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/24/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023] Open
Abstract
Selective clamping during robot-assisted partial nephrectomy (RAPN) may reduce ischemia-related functional impairment. The intraoperative use of 3D-virtual models (3DVMs) can improve surgical planning, resulting in a greater success rate for selective clamping. Our goal is to introduce a new generation of 3DVMs, which consider the perfusion volumes of the kidney. Patients listed for RAPN from 2021 to 2022 were recruited. A selective clamping strategy was designed and intraoperatively performed based on the specifically generated 3DVMs. The effectiveness of selective clamping was evaluated using near-infrared-fluorescence imaging (NIRF) and 3DVM. Perfusion areas extensions were compared, and relevant preoperative characteristics were analyzed. In 61 of 80 (76.25%) cases, selective clamping was performed. The concordance between the 3DVM areas and the NIRF-enhanced areas was verified (k = 0.91). According to the distribution of perfused areas crossing the tumor, there were one, two, three, four, and five crossing areas, with relative perfusion rates of 13.75%, 35%, 32.5%, 13.75%, and 5%, respectively. Lesion diameter and mesorenal location were the only factors related to a higher number (>3) of perfusion volumes crossing the lesion. The implementation of mathematical algorithms to 3DVMs allows for precise estimation of the perfusion zone of each arterial branch feeding the organ, leading to the performance of safe and effective pedicle management planning.
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Affiliation(s)
- Daniele Amparore
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, 10043 Orbassano, Italy
| | - Federico Piramide
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, 10043 Orbassano, Italy
| | - Paolo Verri
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, 10043 Orbassano, Italy
| | - Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, 10060 Candiolo, Italy
| | - Sabrina De Cillis
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, 10043 Orbassano, Italy
| | - Alberto Piana
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, 10043 Orbassano, Italy
| | - Gabriele Volpi
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, 10060 Candiolo, Italy
| | - Mariano Burgio
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, 10043 Orbassano, Italy
| | - Giovanni Busacca
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, 10043 Orbassano, Italy
| | - Marco Colombo
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, 10043 Orbassano, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, 10043 Orbassano, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, 10043 Orbassano, Italy
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Jiang YL, Yu DD, Xu Y, Zhang MH, Peng FS, Li P. Comparison of perioperative outcomes of robotic vs. laparoscopic partial nephrectomy for renal tumors with a RENAL nephrometry score ≥7: A meta-analysis. Front Surg 2023; 10:1138974. [PMID: 37009605 PMCID: PMC10050427 DOI: 10.3389/fsurg.2023.1138974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
IntroductionTo compare the perioperative outcomes of robotic partial nephrectomy (RPN) vs. laparoscopic partial nephrectomy (LPN) for complex renal tumors with a RENAL nephrometry score ≥7.MethodsWe searched PubMed, EMBASE and the Cochrane Central Register for studies from 2000 to 2020 to evaluate the perioperative outcomes of RPN and LPN in patients with a RENAL nephrometry score ≥7. We used RevMan 5.2 to pool the data.ResultsSeven studies were acquired in our study. No significant differences were found in the estimated blood loss (WMD: 34.49; 95% CI: −75.16–144.14; p = 0.54), hospital stay (WMD: −0.59; 95% CI: −1.24–0.06; p = 0.07), positive surgical margin (OR: 0.85; 95% CI: 0.65–1.11; p = 0.23), major postoperative complications (OR: 0.90; 95% CI: 0.52–1.54; p = 0.69) and transfusion (OR: 0.72; 95% CI: 0.48–1.08; p = 0.11) between the groups. RPN showed better outcomes in the operating time (WMD: −22.45; 95% CI: −35.06 to −9.85; p = 0.0005), postoperative renal function (WMD: 3.32; 95% CI: 0.73–5.91; p = 0.01), warm ischemia time (WMD: −6.96; 95% CI: −7.30–−6.62; p < 0.0001), conversion rate to radical nephrectomy (OR: 0.34; 95% CI: 0.17 to 0.66; p = 0.002) and intraoperative complications (OR: 0.52; 95% CI: 0.28–0.97; p = 0.04).DiscussionRPN is a safe and effective alternative to LPNs for or the treatment of complex renal tumors with a RENAL nephrometry score ≥7 with a shorter warm ischemic time and better postoperative renal function.
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Bertolo R, Amparore D, Diana P, Erdem S, Marandino L, Carbonara U, Borregales LD, Muselaers S, Pavan N, Pecoraro A, Roussel E, Pecoraro A, Marchioni M, Campi R. Cryoablation of small renal masses in patients with solitary kidneys: worth crossing the road for? Minerva Urol Nephrol 2022; 74:794-798. [PMID: 36629808 DOI: 10.23736/s2724-6051.22.05184-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Riccardo Bertolo
- Department of Urology, San Carlo Di Nancy Hospital, Rome, Italy -
| | - Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Pietro Diana
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - Selcuk Erdem
- Division of Urologic Oncology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Laura Marandino
- Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Umberto Carbonara
- Unit of Andrology and Kidney Transplantation, Department of Emergency and Organ Transplantation-Urology, University of Bari, Bari, Italy
| | - Leonardo D Borregales
- Department of Urology, Weill Cornell Medicine/New York-Presbyterian, New York, NY, USA
| | - Stijn Muselaers
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicola Pavan
- Unit of Urology, Department of Surgical, Oncological and Oral Sciences, P. Giaccone University Hospital, Palermo, Italy
| | - Angela Pecoraro
- Division of Urology, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Eduard Roussel
- Department of Urology, University Hospitals of Leuven, Leuven, Belgium
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, G. D'Annunzio Chieti-Pescara University, Chieti, Italy.,Department of Urology, SS Annunziata Hospital, G. D'Annunzio Chieti-Pescara University, Chieti, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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BERTOLO R, AMPARORE D, ERDEM S, MARCHIONI M, INGELS A, KARA Ö, CARBONARA U, PECORARO A, PAVAN N, MARANDINO L, MUSELAERS S, ROUSSEL E, CAMPI R. Renal surgery in elderly: not all partial nephrectomies should be treated equally. Minerva Urol Nephrol 2022; 74:492-496. [DOI: 10.23736/s2724-6051.22.04956-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Di Maida F, Campi R, Lane BR, De Cobelli O, Sanguedolce F, Hatzichristodoulou G, Antonelli A, Grosso AA, Noyes S, Rodriguez-Faba O, Keeley FX, Langenhuijsen J, Musi G, Klatte T, Roscigno M, Akdogan B, Furlan M, Simeone C, Karakoyunlu N, Marszalek M, Capitanio U, Volpe A, Brookman-May S, Gschwend JE, Smaldone MC, Uzzo RG, Kutikov A, Minervini A. Predictors of Positive Surgical Margins after Robot-Assisted Partial Nephrectomy for Localized Renal Tumors: Insights from a Large Multicenter International Prospective Observational Project (The Surface-Intermediate-Base Margin Score Consortium). J Clin Med 2022; 11:jcm11071765. [PMID: 35407375 PMCID: PMC8999836 DOI: 10.3390/jcm11071765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/12/2022] [Accepted: 03/19/2022] [Indexed: 12/30/2022] Open
Abstract
Background: To explore predictors of positive surgical margins (PSM) after robotic partial nephrectomy (PN) in a large multicenter international observational project, harnessing the Surface-Intermediate-Base (SIB) margin score to report the resection technique after PN in a standardized way. Methods: Data from consecutive patients with cT1-2N0M0 renal masses treated with PN from September 2014 to March 2015 at 16 tertiary referral centers and included in the SIB margin score International Consortium were prospectively collected. For the present study, only patients treated with robotic PN were included. Uni- and multivariable analysis were fitted to explore clinical and surgical predictors of PSMs after PN. Results: Overall, 289 patients were enrolled. Median (IQR) preoperative tumor size was 3.0 (2.3−4.2) cm and median (IQR) PADUA score was 8 (7−9). SIB scores of 0−2 (enucleation), 3−4 (enucleoresection) and 5 (resection) were reported in 53.3%, 27.3% and 19.4% of cases, respectively. A PSM was recorded in 18 (6.2%) patients. PSM rate was 4.5%, 11.4% and 3.6% in case of enucleation, enucleoresection and resection, respectively. Patients with PSMs had tumors with a higher rate of contact with the urinary collecting system (55.6% vs. 27.3%; p < 0.001) and a longer median warm ischemia time (22 vs. 16 min; p = 0.02) compared with patients with negative surgical margins, while no differences emerged between the two groups in terms of other tumor features (i.e., pathological diameter, PADUA score). In multivariable analysis, only enucleoresection (SIB score 3−4) versus enucleation (SIB score 0−2) was found to be an independent predictor of PSM at final pathology (HR: 2.68; 95% CI: 1.25−7.63; p = 0.04), while resection (SIB score 5) was not. Conclusions: In our experience, enucleoresection led to a higher risk of PSMs as compared to enucleation. Further studies are needed to assess the differential impacts of resection technique and surgeon’s experience on margin status after robotic PN.
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Affiliation(s)
- Fabrizio Di Maida
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, 50134 Florence, Italy; (F.D.M.); (A.A.G.)
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Department of Experimental and Clinical Medicine, University of Florence, Careggi Hospital, 50134 Florence, Italy;
| | - Brian R. Lane
- Department of Urology, Spectrum Health Medical Group, Grand Rapids, MI 49508, USA; (B.R.L.); (S.N.)
| | - Ottavio De Cobelli
- Department of Urology, European Institute of Oncology (IEO), University of Milan, 20141 Milan, Italy; (O.D.C.); (G.M.)
| | - Francesco Sanguedolce
- Bristol Urological Institute, Southmead Hospital, Bristol BS10 5NB, UK; (F.S.); (F.X.K.)
- Uro-Oncology Unit, Fundacio Puigvert, 08025 Barcelona, Spain;
| | - Georgios Hatzichristodoulou
- Department of Urology, Rechts der Isar University Hospital, Technical University of Munich, 81675 Munich, Germany; (G.H.); (J.E.G.)
- Department of Urology, Martha-Maria Hospital Nuremberg, 90491 Nurnberg, Germany
| | - Alessandro Antonelli
- Department of Urology, University of Brescia, 25121 Brescia, Italy; (A.A.); (M.F.); (C.S.)
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, 37126 Verona, Italy
| | - Antonio Andrea Grosso
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, 50134 Florence, Italy; (F.D.M.); (A.A.G.)
| | - Sabrina Noyes
- Department of Urology, Spectrum Health Medical Group, Grand Rapids, MI 49508, USA; (B.R.L.); (S.N.)
| | | | - Frank X. Keeley
- Bristol Urological Institute, Southmead Hospital, Bristol BS10 5NB, UK; (F.S.); (F.X.K.)
| | - Johan Langenhuijsen
- Department of Urology, Radboud University Nijmegen Medical Centre, 6525 GA Nijmegen, The Netherlands;
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology (IEO), University of Milan, 20141 Milan, Italy; (O.D.C.); (G.M.)
| | - Tobias Klatte
- Department of Urology, Royal Bournemouth Hospital, Bournemouth BH7 7DW, UK;
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria
| | - Marco Roscigno
- Department of Urology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy;
| | - Bulent Akdogan
- Department of Urology, School of Medicine, Hacettepe University, Ankara 06800, Turkey;
| | - Maria Furlan
- Department of Urology, University of Brescia, 25121 Brescia, Italy; (A.A.); (M.F.); (C.S.)
| | - Claudio Simeone
- Department of Urology, University of Brescia, 25121 Brescia, Italy; (A.A.); (M.F.); (C.S.)
| | - Nihat Karakoyunlu
- Department of Urology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara 06145, Turkey;
| | - Martin Marszalek
- Department of Urology and Andrology, Sozialmedizinishes Zentrum Ost-Donauspital, 1220 Vienna, Austria;
- Department of Urology, Graz Medical University, 8036 Graz, Austria
| | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, 20132 Milan, Italy;
| | - Alessandro Volpe
- Department of Urology, Maggiore della Carità Hospital, University of Eastern Piedmont, 28100 Novara, Italy;
| | - Sabine Brookman-May
- Department of Urology, Campus Grosshadern, Ludwig-Maximilians University (LMU), 80539 Munich, Germany;
- Janssen Pharma Research and Development, San Diego, CA 92121, USA
| | - Jürgen E. Gschwend
- Department of Urology, Rechts der Isar University Hospital, Technical University of Munich, 81675 Munich, Germany; (G.H.); (J.E.G.)
| | - Marc C. Smaldone
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; (M.C.S.); (R.G.U.); (A.K.)
| | - Robert G. Uzzo
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; (M.C.S.); (R.G.U.); (A.K.)
| | - Alexander Kutikov
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; (M.C.S.); (R.G.U.); (A.K.)
| | - Andrea Minervini
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, 50134 Florence, Italy; (F.D.M.); (A.A.G.)
- Correspondence:
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11
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Bertolo R, Bove P, Sandri M, Cindolo L, Annino F, Leonardo C, Parma P, Nucciotti R, Porreca A, Falsaperla M, Veneziano D, Celia A, Schips L, Simeone C, Carini M, Minervini A, Antonelli A. Cross-analysis of two randomized controlled trials to compare pure versus robot-assisted laparoscopic approach during off-clamp partial nephrectomy. Minerva Urol Nephrol 2022; 74:5-10. [PMID: 35272452 DOI: 10.23736/s2724-6051.22.04779-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Riccardo Bertolo
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy -
| | - Pierluigi Bove
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy.,Urology Unit, Department of Surgery, Tor Vergata University, Rome, Italy
| | - Marco Sandri
- Data Methods and System Statistical Laboratory, University of Brescia, Brescia, Italy
| | - Luca Cindolo
- Unit of Urology, Villa Stuart Private Hospital, Rome, Italy
| | | | | | - Paolo Parma
- Department of Urology, Carlo Poma Hospital, Mantova, Italy
| | | | - Angelo Porreca
- Unit of Urology, Polyclinic of Abano, Abano Terme, Padua, Italy
| | | | - Domenico Veneziano
- Department of Urology and Kidney Transplantation, O.O. Riuniti BMM, Reggio Calabria, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano Del Grappa, Vicenza, Italy
| | - Luigi Schips
- Unit of Urology, SS Annunziata Hospital, University of Chieti, Chieti, Italy
| | - Claudio Simeone
- Unit of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Marco Carini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
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12
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External Validation of a Novel Comprehensive Trifecta System in Predicting Oncologic and Functional Outcomes of Partial Nephrectomy: Results of a Multicentric Series. J Clin Med 2022; 11:jcm11030796. [PMID: 35160248 PMCID: PMC8837057 DOI: 10.3390/jcm11030796] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 01/27/2023] Open
Abstract
Background: To validate a novel trifecta for evaluating outcomes of partial nephrectomy (PN) on a multicentric dataset. Methods: Between 2007 and 2020, three renal cancer databases were queried for patients with solitary renal masses who underwent PN (n = 649). Trifecta was estimated for overall cohort and contributing centers. Overall survival (OS), cancer-specific survival (CSS) and end-stage renal disease (ESRD) probabilities were assessed by Kaplan–Meier. Cox regression was used to identify predictors of OS, CSS, ESRD. For all analyses, a p < 0.05 was considered significant. Results: At a median follow-up of 22.7 months (IQR 12.5–76.5) overall trifecta was 76.7% [Centre A; (n = 230; 68.6%), B (n = 68; 77.3%), C (n = 200; 88.4%); p = 0.001). On Kaplan–Meier, patients achieving trifecta exhibited higher OS (p = 0.024), higher CSS (p = 0.015) and lower ESRD rates (p = 0.024). On multivariable analysis, age (HR 1.04; 95% CI 1.01–1.08) and trifecta (HR 0.34; 95% CI 0.15–0.76) were independent predictors of OS while pT stage (HR 1.95; 95% CI 0.45–8.43) and trifecta (HR 0.33; 95% CI 0.16–0.67) were predictors of CSS (each p < 0.01). Preoperative CKD stage ≥ 3a (HR 13.1; 95% CI 4.07–42.6) and trifecta (HR 0.41; 95% CI 0.19–0.87) were independent predictors of ESRD (each p < 0.05). Conclusions: On external validation, trifecta was an independent predictor of all PN endpoints, regardless of hilar control and ischemia duration.
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13
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Abdel Raheem A, Alowidah I, Capitanio U, Montorsi F, Larcher A, Derweesh I, Ghali F, Mottrie A, Mazzone E, DE Naeyer G, Campi R, Sessa F, Carini M, Minervini A, Raman JD, Rjepaj CJ, Kriegmair MC, Autorino R, Veccia A, Mir MC, Claps F, Choi YD, Ham WS, Tadifa JP, Santok GD, Furlan M, Simeone C, Bada M, Celia A, Carrion DM, Aguilera Bazan A, Ruiz CB, Malki M, Barber N, Hussain M, Micali S, Puliatti S, Alwahabi A, Alqahtani A, Rumaih A, Ghaith A, Ghoneem AM, Hagras A, Eissa A, Alenzi MJ, Pavan N, Traunero F, Antonelli A, Porcaro AB, Illiano E, Costantini E, Rha KH. Warm ischemia time length during on-clamp partial nephrectomy: dose it really matter? Minerva Urol Nephrol 2021; 74:194-202. [PMID: 34308610 DOI: 10.23736/s2724-6051.21.04466-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The impact of warm ischemia time (WIT) on renal functional recovery remains controversial. We examined the length of WIT >30 min. on the long-term renal function following on-clamp partial nephrectomy (PN). METHODS Data from 23 centers for patients undergoing on-clamp PN between 2000 and 2018 were analyzed. We included patients with two kidneys, single tumor, cT1, minimum 1-year followup, and preoperative eGFR ≥60 ml/min/1.73m2. Patients were divided into two groups according to WIT length: group Ⅰ "WIT ≤30 min." and group Ⅱ "WIT >30 min.". A propensity-score matched analysis (1:1 match) was performed to eliminate potential confounding factors between groups. We compared eGFR values, eGFR (%) preservation, eGFR decline, events of chronic kidney disease (CKD) upgrading, and CKD-free progression rates between both groups. Cox regression analysis evaluated WIT impact on upgrading of CKD stages. RESULTS The primary cohort consisted of 3526 patients: group Ⅰ (n=2868) and group Ⅱ (n=658). After matching the final cohort consisted of 344 patients in each group. At last followup, there were no significant differences in median eGFR values at 1, 3, 5, and 10 years (P>0.05) between the matched groups. In addition, the median eGFR (%) preservation and absolute eGFR change were similar (89% in group Ⅰ vs. 87% in group Ⅱ, p=0.638) and (-10 in group Ⅰ vs. -11 in group Ⅱ, p=0.577), respectively. The 5 years new-onset CKD-free progression rates were comparable in the non-matched groups (79% in group Ⅰ vs. 81% in group Ⅱ, log-rank, p=0.763) and the matched groups (78.8% in group Ⅰ vs. 76.3% in group Ⅱ, log-rank, p=0.905). Univariable Cox regression analysis showed that WIT >30 min. was not a predictor of overall CKD upgrading (HR:0.953, 95%CI 0.829-1.094, p=0.764) nor upgrading into CKD stage ≥Ⅲ (HR:0.972, 95%CI 0.805-1.173, p=0.764). Retrospective design is a limitation of our study. CONCLUSIONS Our analysis based on a large multicenter international cohort study suggests that WIT length during PN has no effect on the long-term renal function outcomes in patients having two kidneys and preoperative eGFR ≥60 ml/min/1.73m2.
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Affiliation(s)
- Ali Abdel Raheem
- Department of Urology, Hersn, Riyadh, Saudi Arabia - .,Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt -
| | | | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandro Larcher
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ithaar Derweesh
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Fady Ghali
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Alexader Mottrie
- Department of Urology, O.L.V. Hospital, Aalst, Belgium.,Department of Urology, Orsi Academy, Melle, Belgium
| | - Elio Mazzone
- Department of Urology, O.L.V. Hospital, Aalst, Belgium.,Department of Urology, Orsi Academy, Melle, Belgium
| | | | - Riccardo Campi
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Sessa
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marco Carini
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Minervini
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Jay D Raman
- Division of Urology, Penn State Health Milton S. Hershey Medical Center Hershey, PA, USA
| | - Chris J Rjepaj
- Division of Urology, Penn State Health Milton S. Hershey Medical Center Hershey, PA, USA
| | - Maximilian C Kriegmair
- Department of Urology, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | | | | | - Maria Carmen Mir
- Department of Urology, Fundación Instituto Valenciano Oncología, Valencia, Spain
| | - Francesco Claps
- Department of Urology, Fundación Instituto Valenciano Oncología, Valencia, Spain
| | - Young Deuk Choi
- Department of Urology, Severance Hospital, Seoul, South Korea
| | - Won S Ham
- Department of Urology, Severance Hospital, Seoul, South Korea
| | - John P Tadifa
- Department of Urology, National Kidney and Transplant Institute, Metro Manila, Philippines
| | - Glen D Santok
- Department of Urology, National Kidney and Transplant Institute, Metro Manila, Philippines
| | - Maria Furlan
- Department of Urology, ASST-Spedali Civili, Brescia, Italy
| | | | - Maida Bada
- Department of Urology, Hospital S. Bassiano, Bassano del Grappa, Vicenza, Italy
| | - Antonio Celia
- Department of Urology, Hospital S. Bassiano, Bassano del Grappa, Vicenza, Italy
| | - Diego M Carrion
- Department of Urology, La Paz University Hospital, Madrid, Spain
| | | | - Cristina B Ruiz
- Department of Urology, La Paz University Hospital, Madrid, Spain
| | - Manar Malki
- Frimley Renal Cancer Centre Frimley Park Hospital Surrey, Camberley UK
| | - Neil Barber
- Frimley Renal Cancer Centre Frimley Park Hospital Surrey, Camberley UK
| | - Muddassar Hussain
- Frimley Renal Cancer Centre Frimley Park Hospital Surrey, Camberley UK
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Ahmed Ghaith
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ayman M Ghoneem
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ayman Hagras
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed Eissa
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohammed J Alenzi
- Department of Urology unit, Al-Jouf University, Al-Jouf, Saudi Arabia
| | | | | | | | - Antonio B Porcaro
- Department of Urology, AOUI Verona, University of Verona, Verona, Italy
| | - Ester Illiano
- Andrological and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy
| | - Elisabetta Costantini
- Andrological and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy
| | - Koon H Rha
- Department of Urology, Severance Hospital, Seoul, South Korea
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14
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Anceschi U, Brassetti A, Tuderti G, Ferriero MC, Minervini A, Mari A, Grosso AA, Carini M, Capitanio U, Larcher A, Montorsi F, Autorino R, Veccia A, Fiori C, Amparore D, Porpiglia F, Eun D, Lee J, Gallucci M, Simone G. Risk factors for progression of chronic kidney disease after robotic partial nephrectomy in elderly patients: results from a multi-institutional collaborative series. Minerva Urol Nephrol 2021; 74:452-460. [PMID: 34156202 DOI: 10.23736/s2724-6051.21.04469-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Robotic partial nephrectomy (RPN) in patients ≥75 years is certainly underused with concerns regarding surgical quality and a negligible impact on renal function. The aim of this study was to identify predictors of progression of chronic kidney disease for purely off-clamp (ocRPN) and on-clamp RPN (onRPN) in elderly patients on a multi-institutional series. METHODS A collaborative minimally-invasive renal surgery dataset was queried for "RPN" performed between July 2007 and March 2021 and "age≥75 years". A total of 205 patients matched the inclusion criteria. Descriptive analyses were used. Frequencies and proportions were reported for categorical variables while medians and interquartile ranges (IQR) were reported for continuous variables. Baseline, perioperative and functional data were compared between groups. New-onset of stages 3b,4,5 CKD in onRPN and ocRPN cohorts was computed by Kaplan-Meier analysis. Univariable and multivariable Cox regression analyses were performed to identify predictors of progression to severe CKD (sCKD [stages ≥3b]). For all statistical analyses, a two-sided p < 0.05 was considered significant. RESULTS Mean age of the cohort considered was 78 years (IQR 76-80). At a median follow-up of 29 months (IQR 14.5-44.5), new onset CKD-3b and CKD-4,5 stages was observed in 16.6% and 2.4% of patients, respectively. At Kaplan-Meier analysis, onRPN was associated with a significantly higher risk of developing sCKD (p=0.002). On multivariable analysis, hypertension (HR 2.64; 95% CI 1.14-6.11; p=0.023), on-clamp approach (HR 3.41; 95% CI 1.50-7.74; p=0.003) non-achievement of trifecta (HR 0.36; 95% CI 0.17-0.78; p=0.01) were independent predictors of sCKD. CONCLUSIONS RPN in patients≥75 years is a safe surgical option. On-clamp approach, hypertension and non-achievement of trifecta were independent predictors of sCKD in the elderly after RPN.
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Affiliation(s)
- Umberto Anceschi
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy -
| | - Aldo Brassetti
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Maria C Ferriero
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Mari
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Antonio A Grosso
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Marco Carini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Umberto Capitanio
- Unit of Urology, Oncology Division, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandro Larcher
- Unit of Urology, Oncology Division, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology, Oncology Division, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Riccardo Autorino
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA
| | - Alessandro Veccia
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Daniele Amparore
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Daniel Eun
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Jennifer Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Michele Gallucci
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Simone
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
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