Robotic-assisted tumor enucleation versus standard margin partial nephrectomy: Perioperative, renal functional, and oncologic outcomes for low and intermediate complexity renal masses. Journal Article

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Authors: Patel, HD; Koehne, EL; Gali, K; Lanzotti, NJ; Rac, G; Desai, S; Pahouja, G; Quek, ML; Gupta, GN
Article Title: Robotic-assisted tumor enucleation versus standard margin partial nephrectomy: Perioperative, renal functional, and oncologic outcomes for low and intermediate complexity renal masses.
Abstract: PURPOSE: Standard margin partial nephrectomy (SPN) with sharp incision across normal renal parenchyma carries perioperative morbidity and renal functional implications. Tumor enucleation (TE) is an alternative approach using a natural plane of dissection around the tumor pseudocapsule to maximize parenchymal preservation. We compared perioperative, functional, and oncologic outcomes for robotic-assisted TE to SPN. MATERIALS AND METHODS: Patients =18 years of age undergoing robotic-assisted TE or SPN were included (2008-2020). Baseline demographics and tumor characteristics were compared. Perioperative, renal functional, and oncologic outcomes were assessed for comparative effectiveness. RESULTS: A total of 467 patients were included with 176 (37.7%) TE and 291 (62.3%) SPN. Baseline characteristics and final histology were comparable; 18% of patients had baseline stage 3 chronic kidney disease. TE had lower median blood loss, operative time, length of stay, and fewer complications compared to SPN. Positive margin rates were higher for TE vs. SPN (8.5% vs. 3.4%, P?=?0.04) with similar recurrence rates (2.3% vs. 3.4%, P?=?0.48) and no difference in cancer-specific or overall survival with median 4.0 years follow-up. Baseline estimated glomerular filtration rate was comparable (76.1 vs. 78.2, P?=?0.63) while renal function in the first year was better preserved with TE (74.6 vs. 68.1, P 0.001) showing an 8-point estimated glomerular filtration rate (P?=?0.001) advantage after adjustment. The rate of stage =3 chronic kidney disease by 12 months was lower for TE compared to SPN (21.5% vs. 34.1%, P?=?0.006). CONCLUSIONS: TE is an alternative approach to SPN associated with favorable perioperative and renal functional outcomes. While positive margin rates are higher, longer-term recurrence rates are no different suggesting pseudocapsule disruption during TE has limited impact on oncologic outcomes.
Journal Title: Urologic oncology
ISSN: 1873-2496; 1078-1439
Publisher: Elsevier Inc  
Date Published: 2022