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Are there limits of robotic partial nephrectomy? TRIFECTA outcomes of open and robotic partial nephrectomy for completely endophytic renal tumors
Author(s) -
Harke Ni.,
Mandel Philipp,
Witt Jorn H.,
Wagner Christian,
Panic Andrej,
Boy Anselm,
Roosen Alexander,
Ubrig Burkhard,
Schneller Andreas,
Schiefelbein Frank,
Wagener Nina,
Honeck Patrick,
Schoen Georg,
Hadaschik Boris,
Michel Maurice S.,
Kriegmair Maximilian C.
Publication year - 2018
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25103
Subject(s) - medicine , nephrectomy , urology , multivariate analysis , stage (stratigraphy) , surgery , kidney , paleontology , biology
Background To compare the outcomes of robot‐assisted (RAPN) and open partial nephrectomy (OPN) for completely endophytic renal tumors. Methods Consecutive patients undergoing OPN or RAPN for entirely endophytic tumors in four high‐volume centers between 2008 and 2016 were identified. Endophytic masses were identified based on sectional imaging. Patient characteristics and surgical outcome were compared using Mann‐Whitney‐ U ‐test and chi‐squared‐tests. Uni‐ and multivariate analyses were performed to identify predictors of TRIFECTA achievement and excisional volume loss. Results Out of 1128 patients, 10.9% (64) of RAPN and 13.9% (76) of OPN underwent surgery for entirely endophytic tumors. Operative time was longer for RAPN (169 vs 140 min, P = 0.03) while ischemia time was shorter (13 vs 18 min, P = 0.001). Complication rates were comparable (21% OPN vs 22% RAPN, P = 0.91) and TRIFECTA achievement was not different between the groups (68% OPN vs 75% RAPN, P = 0.39). In multivariate analyses type of surgery was not associated with TRIFECTA achievement or excisional volume loss. Here, only tumor complexity (OR 0.48, P = 0.001) and size (OR 1.01, P = 0.002) were independent predictors. Conclusion For entirely endophytic tumors, both RAPN and OPN offer good TRIFECTA achievement. This encourages the use of NSS even for these highly complex tumors using the surgeon's preferred approach.