The Impact of Surgical Strategy in Robot-assisted Partial Nephrectomy: Is It Beneficial to Treat Anterior Tumours with Transperitoneal Access and Posterior Tumours with Retroperitoneal Access?

Published on Feb 1, 2021in European Urology Oncology
· DOI :10.1016/J.EUO.2018.12.010
Paolo Dell'Oglio28
Estimated H-index: 28
(UniSR: Vita-Salute San Raffaele University),
Geert De Naeyer18
Estimated H-index: 18
+ 14 AuthorsAlessandro Larcher29
Estimated H-index: 29
(UniSR: Vita-Salute San Raffaele University)
Abstract Available comparison of transperitoneal robot-assisted partial nephrectomy (tRAPN) and retroperitoneal robot-assisted partial nephrectomy (rRAPN) does not consider tumour's location. The aim of this study was to compare perioperative morbidity, and functional and pathological outcomes after tRAPN and rRAPN, with the specific hypothesis that tRAPN for anterior tumours and rRAPN for posterior tumours might be a beneficial strategy. A large global collaborative dataset of 1169 cT1-2N0M0 patients was used. Propensity score matching, and logistic and linear regression analyses tested the effect of tRAPN versus rRAPN on perioperative outcomes. No differences were observed between rRAPN and tRAPN with respect to complications, operative time, length of stay, ischaemia time, median 1-yr estimated glomerular filtration rate (eGFR), and positive surgical margins (all p>0.05). Median estimated blood loss and postoperative eGFR were 50 versus100ml (p 0.05). The techniques of rRAPN and tRAPN offer equivalent perioperative morbidity, and functional and pathological outcomes, regardless of tumour's location. Patient summary Robot-assisted partial nephrectomy can be performed with a transperitoneal or a retroperitoneal approach regardless of the specific position of the tumour, with equivalent outcomes for the patient.
#1Alessandro Larcher (UniSR: Vita-Salute San Raffaele University)H-Index: 29
#2Fabio Muttin (UniSR: Vita-Salute San Raffaele University)H-Index: 5
Last. Alexandre MottrieH-Index: 34
view all 13 authors...
Abstract Robot-assisted partial nephrectomy (RAPN) outcomes might be importantly affected by increasing surgical experience (EXP). The aim of the study is to investigate the effect of EXP on warm ischemia time (WIT), presence of at least one Clavien-Dindo ≥2 postoperative complication (CD ≥ 2), and positive surgical margins (PSMs) to define the learning curve for RAPN. We evaluated 457 consecutive patients diagnosed with a cT1-T2 renal mass were evaluated. EXP was defined as the total number of ...
38 CitationsSource
#1Giovanni Cacciamani (SC: University of Southern California)H-Index: 17
#2Luis Medina (SC: University of Southern California)H-Index: 8
Last. Inderbir S. Gill (SC: University of Southern California)H-Index: 135
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Purpose: Utilization of robotic partial nephrectomy has increased significantly. We report a literature wide systematic review and cumulative meta-analysis to critically evaluate the impact of surgical factors on the operative, perioperative, functional, oncologic and survival outcomes in patients undergoing robotic partial nephrectomy.Materials and Methods: All English language publications on robotic partial nephrectomy comparing various surgical approaches were evaluated. We followed the PRIS...
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#1Nicola Pavan (UniTS: University of Trieste)H-Index: 14
#2Ithaar H. Derweesh (UC San Diego Health System)H-Index: 43
Last. Riccardo Autorino (VCU: Virginia Commonwealth University)H-Index: 68
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Abstract Objectives: To compare the outcomes of retroperitoneal vs transperitoneal approach for robot-assisted partial nephrectomy (RAPN). Materials and Methods: A systematic review of the literature was performed through January 2018 using PubMed, Scopus, and Ovid databases. Article selection proceeded according to the search strategy based on PRISMA criteria. Only studies comparing retroperitoneal to transperitoneal approach for RAPN were deemed eligible for inclusion. Results: Seven retrospec...
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#1Sean P. Stroup (NMCSD: Naval Medical Center San Diego)H-Index: 10
#1Sean P. Stroup (NMCSD: Naval Medical Center San Diego)H-Index: 20
Last. Ithaar H. Derweesh (UCSD: University of California, San Diego)H-Index: 43
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Background We compared quality outcomes between transperitoneal (TRPN) and retroperitoneal robotic partial nephrectomy (RRPN).
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#1Matthew J. Maurice (Cleveland Clinic)H-Index: 17
#1Matthew J. Maurice (Cleveland Clinic)H-Index: 14
Last. Michael D. Stifelman (Hackensack University Medical Center)H-Index: 4
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Abstract Introduction: We sought to compare surgical outcomes between transperitoneal and retroperitoneal robotic partial nephrectomy (RPN) for posterior tumors. Patients and Methods: Using our multi-institutional RPN database, we reviewed 610 consecutive cases for posterior renal masses treated between 2007 and 2015. Primary outcomes were complications, operative time, length of stay (LOS), surgical margin status, and estimated glomerular filtration rate (eGFR) preservation. Secondary outcomes ...
19 CitationsSource
#1Alessandro Larcher (UniSR: Vita-Salute San Raffaele University)H-Index: 29
#2Umberto Capitanio (UniSR: Vita-Salute San Raffaele University)H-Index: 62
Last. Roberto Bertini (UniSR: Vita-Salute San Raffaele University)H-Index: 31
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Purpose: There is no consensus regarding a protective effect on mortality due to a cause other than cancer in patients treated with elective nephron sparing surgery relative to their radical nephrectomy counterparts. We test whether the protective effect of nephron sparing surgery relative to radical nephrectomy is universal or present in specific subgroups of patients.Materials and Methods: A collaborative database of 5 institutions was queried to evaluate 1,783 patients without chronic kidney ...
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#1Aaron A. Laviana (UCLA: University of California, Los Angeles)H-Index: 8
#2Chandan R. Kundavaram (UCLA: University of California, Los Angeles)H-Index: 2
Last. Jim C. Hu (UCLA: University of California, Los Angeles)H-Index: 68
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Abstract Introduction We report the implementation of time driven, activity based costing for competing treatments of small renal masses at an academic referral center. Methods To use time driven, activity based costing we developed a process map outlining the steps to treat small renal masses. We then derived the costs of supplying every resource per unit time. Known as the capacity cost rate, this included equipment and its depreciation (eg price per minute of the operating room table), person...
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#1Alessandro Larcher (UdeM: Université de Montréal)H-Index: 29
#1Alessandro Larcher (UdeM: Université de Montréal)H-Index: 18
Last. Pierre I. Karakiewicz (UdeM: Université de Montréal)H-Index: 116
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Abstract Background Current guidelines recommend local tumour ablation (LTA) over partial nephrectomy (PN) in nonsurgical candidates; however, objective definitions of these candidates are lacking. Objective To identify specific patients who would benefit from LTA more than PN. Design, setting, and participants A population-based assessment was performed of 2476 patients in the Surveillance Epidemiology and End Results–Medicare database who had cT1a kidney cancer treated with either LTA or PN, b...
38 CitationsSource
#1H KimEric (WashU: Washington University in St. Louis)H-Index: 1
#1Eric H. Kim (WashU: Washington University in St. Louis)H-Index: 16
Last. Robert S. Figenshau (WashU: Washington University in St. Louis)H-Index: 26
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Abstract Purpose: To compare perioperative outcomes, specifically hospital length of stay (LOS), after retroperitoneal and conventional transperitoneal robot-assisted partial nephrectomy (RAPN). Patients and Methods: We retrospectively compared consecutive patients with a posterior renal mass undergoing retroperitoneal RAPN (n=116) versus transperitoneal RAPN (n=97) at our institution between July 2007 and March 2014. The surgical approach was based on patient and tumor characteristics, history ...
25 CitationsSource
#1Daniel Dindo (Triemli Hospital)H-Index: 23
According to Donabedian, medical quality is determined by structure, process and outcome. In surgery, outcome is still the most frequently used indicator of surgical quality. However, there is still a lack of a precise definition of a ‘good’ or ‘bad’ surgical outcome. In 1992, it was proposed that ‘negative outcome’ should be subdivided into complication, failure to cure and sequelae . Complications were defined as ‘any deviation from the normal postoperative course’. Conditions, which are inher...
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Cited By6
#1Umberto CarbonaraH-Index: 3
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PURPOSE To assess the outcomes of retroperitoneal robot-assisted partial nephrectomy (r-RAPN) in a large cohort of patients with postero-lateral renal masses comparing to those of transperitoneal RAPN (t-RAPN). METHODS Patients with posterior (R.E.N.A.L. score grading P) or lateral (grading X) renal mass who underwent RAPN in six high-volume US and European centers were identified and stratified into two groups according to surgical approach: r-RAPN ("study group") and t-RAPN ("control group"). ...
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#2Giuseppe FallaraH-Index: 3
Last. Umberto CapitanioH-Index: 62
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PURPOSE OF REVIEW Nephron-sparing partial nephrectomy is the state of the art for localized small renal mass and it is gaining attention also for more advanced cases. In the present narrative review, we discuss the new developments that have occurred in the advancement of this approach over the past few years. RECENT FINDINGS Off-clamp, selective/superselective clamp and early-unclamping techniques are safe and feasible approaches, with potentially superior functional outcomes, and noninferior c...
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#2Zhenghuan Liu (Sichuan University)
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PURPOSE To systematically assess the perioperative outcomes of retroperitoneal (RP) and transperitoneal (TP) approaches in robot-assisted partial nephrectomy (RAPN), we conducted an updated meta-analysis. METHODS A literature retrieval of multi-database including PubMed, Web of Science, Embase, Cochrane Library, and CNKI was performed to identify eligible comparative studies from the inception dates to January 2021. Perioperative outcomes included operative time (OT), estimated blood loss (EBL),...
#1Toshio TakagiH-Index: 21
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#2Xue Shao (Chinese PLA General Hospital)H-Index: 1
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Background: To compare perioperative, functional and oncological outcomes between transperitoneal robotic partial nephrectomy (TRPN) and retroperitoneal robotic partial nephrectomy (RRPN). Methods: A literature searching of Pubmed, Embase, Cochrane Library and Web of Science was performed in August, 2020. Pooled odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were estimated using fixed-effect or random-effect model. Publication bias was evaluated with funn...
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