MP67-03 IMPACT OF NUMBER OF INNER AND OUTER RENORRAPHY STITCHES ON FUNCTIONAL OUTCOMES AFTER ROBOTIC ASSISTED PARTIAL NEPHRECTOMY

摘要

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy V (MP67)1 May 2024MP67-03 IMPACT OF NUMBER OF INNER AND OUTER RENORRAPHY STITCHES ON FUNCTIONAL OUTCOMES AFTER ROBOTIC ASSISTED PARTIAL NEPHRECTOMY Giuseppe Garofano, Cesare Saitta, Marco Paciotti, Pietro Diana, Vittorio Fasulo, Margaret F. Meagher, Alessandro Uleri, Edoardo Beatrici, Andrea Piccolini, Stefano Mancon, Fabio De Carne, Federica Sordelli, Paola Arena, Andrea Gobbo, Kit Yuen, Alberto Saita, Massimo Lazzeri, Rodolfo Hurle, Giorgio F. Guazzoni, Giovanni Lughezzani, Paolo Casale, Ithaar Derweesh, and Nicolò M. Buffi Giuseppe GarofanoGiuseppe Garofano , Cesare SaittaCesare Saitta , Marco PaciottiMarco Paciotti , Pietro DianaPietro Diana , Vittorio FasuloVittorio Fasulo , Margaret F. MeagherMargaret F. Meagher , Alessandro UleriAlessandro Uleri , Edoardo BeatriciEdoardo Beatrici , Andrea PiccoliniAndrea Piccolini , Stefano ManconStefano Mancon , Fabio De CarneFabio De Carne , Federica SordelliFederica Sordelli , Paola ArenaPaola Arena , Andrea GobboAndrea Gobbo , Kit YuenKit Yuen , Alberto SaitaAlberto Saita , Massimo LazzeriMassimo Lazzeri , Rodolfo HurleRodolfo Hurle , Giorgio F. GuazzoniGiorgio F. Guazzoni , Giovanni LughezzaniGiovanni Lughezzani , Paolo CasalePaolo Casale , Ithaar DerweeshIthaar Derweesh , and Nicolò M. BuffiNicolò M. Buffi View All Author Informationhttps://doi.org/10.1097/01.JU.0001009496.54470.10.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Hemostasis is a critical step during robot-assisted partial nephrectomy (RAPN), typically achieved by suturing renal parenchyma. However, the suturing process itself can result in the loss of healthy parenchyma and potentially have a detrimental impact on renal function. Nevertheless, there is a dearth of data elucidating impact of number of outer and inner renorraphy stitches on functional outcomes. METHODS: We queried our Institutional database for patients older than 18 years affected by renal cell carcinoma who underwent robotic-assisted PN (RAPN) between January 2015 and March 2023. Patients with clinical metastasis and with incomplete data were excluded from analysis. Type and number of stitches performed was dictated by surgeon's preferences. Functional outcomes analyzed were post-surgical acute kidney injury (AKI), defined according to RIFLE criteria (>25% reduction of preoperative eGFR), and eGFR at 6 months. Multivariable logistic regression (MLR) model and linear regression model, adjusted for RENAL score, age and tumor size, were fitted to test the association between number of sutures and post-surgical AKI and eGFR at 6 months, respectively. RESULTS: Overall, 269 patients (174 male vs. 95 female) were analyzed with a median follow up of 31 months (IQR 15-40 months). Median tumor size was 3 (IQR 2.3-4.2 cm) cm, and postoperative AKI occurred in 49 (22%) patients. Median number of inner and outer renorraphy stitches were not different [medullary sutures 2 (IQR 1-3) vs. cortical sutures 3 (IQR 2-4), p=0.24]. MLR adjusted for RENAL score, age, and clinical tumor size revealed increasing number of outer renorraphy stitches (OR 1.48, p=0.031) as independent risk factor associated with post-surgical AKI, while increasing inner renorraphy stitches was not (p=0.1). Linear regression model revealed number of cortical sutures associated with eGFR at 6 months (coefficient 3.04, p=0.033), while number of medullary sutures was not (p=0.5). CONCLUSIONS: An increased number of outer renorraphy stitches during RAPN is significantly associated with postoperative AKI and with reduced eGFR at 6 months in a statistically significant manner. These findings are hypothesis generated and may guide informed decision making with respect to the type of sutures to be used and their functional effects. Further investigation is requisite. Source of Funding: None © 2024 by American Urological