Perioperative and renal functional outcomes of elective robot‐assisted partial nephrectomy ( <scp>RAPN</scp> ) for renal tumours with high surgical complexity

Abstract

Objective To evaluate the perioperative, postoperative and functional outcomes of robot‐assisted partial nephrectomy ( RAPN ) for renal tumours with high surgical complexity at a large volume centre. Patients and Methods Perioperative and functional outcomes of RAPNs for renal tumours with a P reoperative A spects and D imensions U sed for an A natomical ( PADUA ) score of ≥10 performed at our institution between S eptember 2006 and D ecember 2012 were collected in a prospectively maintained database and analysed. Surgical complications were graded according to the C lavien‐ D indo classification. Serum creatinine and estimated glomerular filtration rate ( eGFR ) were assessed at the third postoperative day and 3–6 months after RAPN . Results In all, 44 RAPNs for renal tumours with PADUA scores of ≥10 were included in the analysis; 23 tumours (52.3%) were cT1b . The median (interquartile range; range) operative time, estimated blood loss and warm ischaemia time ( WIT ) were 120 (94, 132; 60–230) min, 150 (80, 200; 25–1200) mL and 16 (13.8, 18; 5–35) min, respectively. Two intraoperative complications occurred (4.5%): one inferior vena caval injury and one bleed from the renal bed, which were both managed robotically. There were postoperative complications in 10 patients (22.7%), of whom four (9.1%) were high C lavien grade, including two bleeds that required percutaneous embolisation, one urinoma that resolved with ureteric stenting and one bowel occlusion managed with laparoscopic adhesiolysis. Two patients (4.5%) had positive surgical margins ( PSMs ) and were followed expectantly with no radiological recurrence at a mean follow‐up of 23 months. The mean serum creatinine levels were significantly increased after surgery (121.1 vs 89.3 μmol/L; P = 0.001), but decreased over time, with no significant differences from the preoperative values at the 6‐month follow‐up (96.4 vs 89.3 μmol/L; P = 0.09). The same trend was seen for eGFR. Conclusion In experienced hands RAPN for renal tumours with a PADUA score of ≥10 is feasible with short WIT , acceptable major complication rate and good long‐term renal functional outcomes. A slightly higher risk of PSMs can be expected due to the high surgical complexity of these lesions. The robotic technology allows a safe expansion of the indications of minimally invasive PN to anatomically very challenging renal lesions in referral centres.