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Robotic partial nephrectomy for clinical T2a renal mass is associated with improved trifecta outcome compared to open partial nephrectomy: a single surgeon comparative analysis.
Ghali, Fady; Elbakry, Amr A; Hamilton, Zachary A; Yim, Kendrick; Nasseri, Ryan; Patel, Sunil; Eldefrawy, Ahmed; Ryan, Stephen; Bradshaw, Aaron W; Meagher, Margaret; Bree, Kelly; Reddy, Madhumitha; Lee, Hak J; Derweesh, Ithaar H.
Afiliación
  • Ghali F; Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, Mail Code 7897, La Jolla, CA, 92093-7897, USA.
  • Elbakry AA; Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, Mail Code 7897, La Jolla, CA, 92093-7897, USA.
  • Hamilton ZA; Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, Mail Code 7897, La Jolla, CA, 92093-7897, USA.
  • Yim K; Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, Mail Code 7897, La Jolla, CA, 92093-7897, USA.
  • Nasseri R; Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, Mail Code 7897, La Jolla, CA, 92093-7897, USA.
  • Patel S; Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, Mail Code 7897, La Jolla, CA, 92093-7897, USA.
  • Eldefrawy A; Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, Mail Code 7897, La Jolla, CA, 92093-7897, USA.
  • Ryan S; Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, Mail Code 7897, La Jolla, CA, 92093-7897, USA.
  • Bradshaw AW; Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, Mail Code 7897, La Jolla, CA, 92093-7897, USA.
  • Meagher M; Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, Mail Code 7897, La Jolla, CA, 92093-7897, USA.
  • Bree K; Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, Mail Code 7897, La Jolla, CA, 92093-7897, USA.
  • Reddy M; Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, Mail Code 7897, La Jolla, CA, 92093-7897, USA.
  • Lee HJ; Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, Mail Code 7897, La Jolla, CA, 92093-7897, USA.
  • Derweesh IH; Department of Urology, UC San Diego School of Medicine, 9400 Campus Point Drive, Mail Code 7897, La Jolla, CA, 92093-7897, USA. iderweesh@gmail.com.
World J Urol ; 38(5): 1113-1122, 2020 May.
Article en En | MEDLINE | ID: mdl-31701211
ABSTRACT

OBJECTIVE:

Utilization of partial nephrectomy (PN) for T2 renal mass is controversial due to concerns regarding burden of morbidity, though most cited data are from open PN (OPN). We compared surgical quality and functional outcomes of RPN and OPN for clinical T2a renal masses (cT2aRM).

METHODS:

Retrospective analysis of 150 consecutive patients [RPN 59/OPN 91] who underwent PN from July 2008 to June 2016. Main outcome was achievement of Trifecta [negative surgical margin, no major urologic complications, and ≥90% preservation of estimated glomerular filtration rate (eGFR)]. Multivariable analysis was performed to identify factors of Trifecta attainment.

RESULTS:

Mean tumor size (RPN 7.9 vs. OPN 8.4 cm, p = 0.139) and median RENAL score (p = 0.361) were similar. No difference was noted for positive margins (RPN 3.4% vs. OPN 1.1%, p = 0.561), ΔeGFR (RPN - 6.2 vs. OPN - 7.8, p = 0.543), and ≥ 90% eGFR recovery (RPN 54.1% vs. OPN 47.2%, p = 0.504). RPN had lower blood loss (p = 0.015), hospital stay (p = 0.013), and Clavien ≥ 3 complications (RPN 5.1% vs. OPN 16.5%, p = 0.041). Trifecta rate was significantly higher in RPN (47.5% vs. 34.0%, p = 0.041). Multivariable analysis demonstrated decreasing RENAL score (OR 1.11, p < 0.001), RPN (OR 1.2, p = 0.013), and decreasing EBL (OR 1.02, p = 0.016) to be associated with Trifecta attainment.

CONCLUSIONS:

RPN provided similar functional and oncologic precision to OPN, while being associated with improvements in major complications, the latter of which was reflected in a higher rate of Trifecta achievement for RPN. RPN may be considered to be a first-line option for select patients with cT2aRM when feasible and safe.
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Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Procedimientos Quirúrgicos Robotizados / Neoplasias Renales / Nefrectomía Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Año: 2020 Tipo del documento: Article

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Procedimientos Quirúrgicos Robotizados / Neoplasias Renales / Nefrectomía Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Año: 2020 Tipo del documento: Article