'Trifecta' outcomes of robot-assisted partial nephrectomy in solitary kidney: a Vattikuti Collective Quality Initiative (VCQI) database analysis.

Publication Title

BJU international

Document Type

Article

Publication Date

1-1-2018

Keywords

Aged; Cohort Studies; Databases, Factual; Disease-Free Survival; Female; Glomerular Filtration Rate; Humans; Internationality; Kidney Neoplasms; Male; Margins of Excision; Middle Aged; Nephrectomy; Operative Time; Outcome Assessment (Health Care); Patient Safety; Postoperative Complications; Retroperitoneal Space; Retrospective Studies; Robotic Surgical Procedures; Solitary Kidney; Survival Analysis

Abstract

OBJECTIVES: To analyse the outcomes of robot-assisted partial nephrectomy (RAPN) in patients with a solitary kidney in a large multi-institutional database.

PATIENTS AND METHODS: In all, 2755 patients in the Vattikuti Collective Quality Initiative database underwent RAPN by 22 surgeons at 14 centres in nine countries. Of these patients, 74 underwent RAPN with a solitary kidney between 2007 and 2016. We retrospectively analysed the functional and oncological outcomes of these 74 patients. A 'trifecta' of outcomes was assessed, with trifecta defined as a warm ischaemia time (WIT) ofmin, negative surgical margins, and no complications intraoperatively or within 3 months of RAPN.

RESULTS: All 74 patients underwent RAPN successfully with one conversion to radical nephrectomy. The median (interquartile range [IQR]) operative time was 180 (142-230) min. Early unclamping was used in 11 (14.9%) patients and zero ischaemia was used in 12 (16.2%). Trifecta outcomes were achieved in 38 of 66 patients (57.6%). The median (IQR) WIT was 15.5 (8.75-20.0) min for the entire cohort. The overall complication rate was 24.1% and the rate of Clavien-Dindo grade ≤II complications was 16.3%. Positive surgical margins were present in four cases (5.4%). The median (IQR) follow-up was 10.5 (2.12-24.0) months. The median drop in estimated glomerular filtration rate at 3 months was 7.0 mL/min/1.72 m

CONCLUSION: Our findings suggest that RAPN is a safe and effective treatment option for select renal tumours in solitary kidneys in terms of a trifecta of negative surgical margins, WIT ofmin, and low operative and perioperative morbidity.

Clinical Institute

Kidney & Diabetes

Specialty

Nephrology

Specialty

Surgery

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