Elsevier

Urology

Volume 77, Issue 4, April 2011, Pages 809-813
Urology

Renal Cancer
Outcomes of Robotic Partial Nephrectomy for Renal Masses With Nephrometry Score of ≥7

https://doi.org/10.1016/j.urology.2010.12.005Get rights and content

Objectives

To evaluate the safety and feasibility of robotic partial nephrectomy for patients with complex renal masses.

Methods

We reviewed the data for 164 consecutive patients who had undergone transperitoneal robotic partial nephrectomy at a tertiary care center from February 2007 to June 2010. Of the 112 patients who had available imaging studies to review, 67 were identified and classified as having a moderately or highly complex renal mass according to the R.E.N.A.L. nephrometry score (≥7) (tumor size—[R]adius, location and depth—[E]xophytic or endophytic; nearness to the renal sinus fat or collecting system [N]; anterior or posterior position [A], and polar vs non-polar location [L]). The preoperative, perioperative, pathologic, and functional outcomes data were analyzed.

Results

The median body mass index was 29.6 kg/m2 (range 19.9-44.8). Of the 67 patients, 32 were men and 35 were women, with 32 right-sided masses and 35 left-sided masses. The median tumor size was 3.7 cm (range 1.2-11), and the median operative time was 180 minutes (range 150-180). The median estimated blood loss was 200 mL (range 100-375), and the warm ischemia time was 19.0 minutes (range 15-26). The median hospital stay was 3.0 days (range 3-4). The estimated glomerular filtration rate was calculated at a median decrease of 11.1 mL/min/1.73 m2 (range 9-1.3). According to the Clavien-Dindo classification of surgical complications, 2 grade 1, 12 grade 2, and 1 grade 3 complication occurred. All margins were pathologically negative, except for 1, and, after a mean follow-up of 10 months, no recurrences had developed.

Conclusions

Robotic partial nephrectomy is a safe and feasible option for moderately or highly complex renal masses determined by the R.E.N.A.L. nephrometry score. The warm ischemia time, blood loss, and complications were increased with highly complex masses.

Section snippets

Material and Methods

From February 2007 to June 2010, 164 patients had undergone RPN. The patient data were entered prospectively into our institutional review board-approved RPN database. Of the 164 patients, the films for 52 patients were not accessible either because of missing hard copies (returned to the patients) or an inability to access them from our electronic system. A total of 112 patients had computed tomography scans available for review, and 6 were excluded because of multiple masses in a single renal

Results

A total of 67 patients who had undergone RPN for moderately or highly complex renal masses were included in the present study. The median tumor size was 3.7 cm (range 1.2-11), with a median operative time of 180 minutes (range 150-180). The median EBL was 200 mL (range 100-375), and the WIT was 19 minutes (range 15-26). The median hospital stay was 3.0 days (range 3-4). The overall results are detailed in Table 3. A total of 15 complications occurred. These were graded using the Clavien-Dindo

Comment

Gettman et al20 were the first to report the use of the da Vinci surgical system (Intuitive Surgical) to assist in laparoscopic partial nephrectomy. They performed 13 procedures, and the mean size of the tumor resected was 3.5 cm, with a mean operative time of 215 minutes and a WIT of 22 minutes. The mean EBL was 170 mL, and the mean LOS was 4.3 days. At 2-11 months of follow-up, no recurrence had been noted.

Since then, >24 reports have been published on the technique and specific institutions'

Conclusions

RPN is safe and feasible for patients with moderate to highly complex renal masses, as defined by a score of ≥7 using the R.E.N.A.L. nephrometry score. The risk of adverse outcomes will be increased for patients with a nephrometry score of ≥10. Larger studies and long-term follow-up are needed to determine efficacy of renal function preservation and oncologic adequacy.

References (30)

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G.-P. Haber is a speaker for Intuitive Surgical; R. J. Stein is a speaker for Applied Medical; and J. H. Kaouk is a speaker for Intuitive Surgical and Covidien.

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