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Partial nephrectomy in solitary kidneys: comparison between open surgery and robotic-assisted laparoscopy on perioperative and functional outcomes (UroCCR-54 study)

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Abstract

Purpose

The management of solitary kidney tumors is a surgical challenge, requiring irreproachable results on both oncological and functional outcomes. The goal of our study was to compare the perioperative results of robotic-assisted partial nephrectomy (RAPN) to open surgery in this indication.

Methods

We led a multicentric study based on the prospectively maintained French national database UroCCR. Patients who underwent partial nephrectomy on a solitary kidney between 1988 and 2020 were included. Clinical and pathological data were retrospectively analyzed. The main outcome of the study was the analysis of the variation of the estimated glomerular filtration rate (eGFR) calculated according to MDRD at 3, 6, 12, and 24 months depending on the chosen surgical approach. The secondary outcomes were the comparison of Trifecta success, perioperative complications, and length of hospital stay.

Results

In total, 150 patients were included; 68 (45%) in the RAPN group and 82 (55%) in the open surgery group. The two groups were comparable for all data. The variation of eGFR at 3, 6, 12, or 24 months was comparable without any significant difference between the 2 groups (p = 0.45). Trifecta was achieved in 40% of the patients in the RAPN group and 33% in the open group (p = 0.42). A significant difference was observed for the length of stay, 5 days for the robot group versus 9 days for the open surgery group (p < 0.0001).

Conclusion

In our study, the surgical approach did not modify functional results and we noted a significant decrease in hospital stay and complications in the RAPN group. RAPN is a safe and efficient method for management of kidney tumors in solitary kidneys.

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References

  1. Ouzaid I, Hermieu J-F, Hupertan V, Dominique S, Delmas V, Ravery V (2014) Évolution des pratiques de la chirurgie rénale avant et après les recommandations de l’AFU de 2010. Prog Urol 24:257–261. https://doi.org/10.1016/j.purol.2013.09.027

    Article  CAS  PubMed  Google Scholar 

  2. Bensalah K, Albiges L, Bernhard J-C, Bigot P, Bodin T, Boissier R et al (2018) French ccAFU guidelines - Update 2018–2020: Management of kidney cancer. Prog Urol 28:S3-31. https://doi.org/10.1016/j.purol.2018.09.009

    Article  CAS  PubMed  Google Scholar 

  3. Larcher A, Capitanio U, De Naeyer G, Fossati N, D’Hondt F, Muttin F et al (2018) Is Robot-assisted Surgery Contraindicated in the Case of Partial Nephrectomy for Complex Tumours or Relevant Comorbidities? A Comparative Analysis of Morbidity, Renal Function, and Oncologic Outcomes. Eur Urol Oncol 1:61–68. https://doi.org/10.1016/j.euo.2018.01.001

    Article  PubMed  Google Scholar 

  4. Brandao LF, Zargar H, Autorino R, Akca O, Laydner H, Samarasekera D et al (2014) Robot-assisted Partial Nephrectomy for ≥7 cm Renal Masses: A Comparative Outcome Analysis. Urology 84:602–608. https://doi.org/10.1016/j.urology.2014.04.015

    Article  PubMed  Google Scholar 

  5. Garisto J, Bertolo R, Dagenais J, Sagalovich D, Fareed K, Fergany A et al (2018) Robotic versus open partial nephrectomy for highly complex renal masses: Comparison of perioperative, functional, and oncological outcomes. Urologic Oncology: Seminars and Original Investigations 36:471.e1-471.e9. https://doi.org/10.1016/j.urolonc.2018.06.012

    Article  PubMed  Google Scholar 

  6. Derweesh IH, Autorino R, Bensalah K, Capitanio U (2017) Partial Nephrectomy for Large or Complex Masses: Option or Obsolete? Eur Urol 72:76–77. https://doi.org/10.1016/j.eururo.2017.01.032

    Article  PubMed  Google Scholar 

  7. Buffi NM, Saita A, Lughezzani G, Porter J, Dell’Oglio P, Amparore D et al (2020) Robot-assisted Partial Nephrectomy for Complex (PADUA Score ≥10) Tumors: Techniques and Results from a Multicenter Experience at Four High-volume Centers. Eur Urol 77:95–100. https://doi.org/10.1016/j.eururo.2019.03.006

    Article  PubMed  Google Scholar 

  8. Kim SP, Campbell SC, Gill I, Lane BR, Van Poppel H, Smaldone MC et al (2017) Collaborative Review of Risk Benefit Trade-offs Between Partial and Radical Nephrectomy in the Management of Anatomically Complex Renal Masses. Eur Urol 72:64–75. https://doi.org/10.1016/j.eururo.2016.11.038

    Article  PubMed  Google Scholar 

  9. Peyronnet B, Khene Z-E, Mathieu R, Bensalah K (2018) Robot-assisted Versus Open Partial Nephrectomy: Do We Really Need More Evidence To End the Debate? European Urology Oncology 1:69–70. https://doi.org/10.1016/j.euo.2018.04.003

    Article  PubMed  Google Scholar 

  10. Malkoc E, Ramirez D, Kara O, Maurice MJ, Nelson RJ, Caputo PA et al (2017) Robotic and open partial nephrectomy for localized renal tumors larger than 7 cm: a single-center experience. World J Urol 35:781–787. https://doi.org/10.1007/s00345-016-1937-9

    Article  PubMed  Google Scholar 

  11. Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 2009;182:844–53. https://doi.org/10.1016/j.juro.2009.05.035.

  12. Khalifeh A, Autorino R, Hillyer SP, Laydner H, Eyraud R, Panumatrassamee K, et al. Comparative Outcomes and Assessment of Trifecta in 500 Robotic and Laparoscopic Partial Nephrectomy Cases: A Single Surgeon Experience. The Journal of Urology 2013.

  13. Fergany AF, Saad IR, Woo L, Novick AC (2006) Open Partial Nephrectomy for Tumor in a Solitary Kidney: Experience With 400 Cases. J Urol 175:1630–1633. https://doi.org/10.1016/S0022-5347(05)00991-2

    Article  PubMed  Google Scholar 

  14. Rogers CG, Singh A, Blatt AM, Linehan WM, Pinto PA (2008) ROBOTIC PARTIAL NEPHRECTOMY FOR COMPLEX RENAL TUMORS: SURGICAL TECHNIQUE. Eur Urol 53:514–521. https://doi.org/10.1016/j.eururo.2007.09.047

    Article  PubMed  Google Scholar 

  15. Verhoest G, Patard JJ, Oger E, Rioux-Leclercq N, Peyronnet B, Bessède T et al (2014) Predictive factors of chronic kidney disease stage V after partial nephrectomy in a solitary kidney: a multi-institutional study. Urologic Oncology: Seminars and Original Investigations 32:28.e21-28.e26. https://doi.org/10.1016/j.urolonc.2012.10.003

    Article  CAS  PubMed  Google Scholar 

  16. Pignot G, Bahi R, Bensalah K, Oger E, Laguna P, Barwari K et al (2014) L’Ischémie n’est pas un facteur d’insuffisance rénale chronique après néphrectomie partielle sur rein unique. Prog Urol 24:822. https://doi.org/10.1016/j.purol.2014.08.087

    Article  CAS  PubMed  Google Scholar 

  17. Cacciamani GE, Medina LG, Gill TS, Mendelsohn A, Husain F, Bhardwaj L et al (2019) Impact of Renal Hilar Control on Outcomes of Robotic Partial Nephrectomy: Systematic Review and Cumulative Meta-analysis. Eur Urol Focus 5:619–635. https://doi.org/10.1016/j.euf.2018.01.012

    Article  PubMed  Google Scholar 

  18. Thompson RH, Lane BR, Lohse CM, Leibovich BC, Fergany A, Frank I et al (2010) Every Minute Counts When the Renal Hilum Is Clamped During Partial Nephrectomy. Eur Urol 58:340–345. https://doi.org/10.1016/j.eururo.2010.05.047

    Article  PubMed  Google Scholar 

  19. Kaczmarek BF, Tanagho YS, Hillyer SP, Mullins JK, Diaz M, Trinh Q-D et al (2013) Off-clamp robot-assisted partial nephrectomy preserves renal function: a multi-institutional propensity score analysis. Eur Urol 64:988–993. https://doi.org/10.1016/j.eururo.2012.10.009

    Article  PubMed  Google Scholar 

  20. Abreu ALC, Gill IS, Desai MM (2011) Zero-ischaemia robotic partial nephrectomy (RPN) for hilar tumours. BJU Int 108:948–954. https://doi.org/10.1111/j.1464-410X.2011.10552.x

    Article  PubMed  Google Scholar 

  21. Bertolo R, Simone G, Garisto J, Nakhoul G, Armanyous S, Agudelo J et al (2019) Off-clamp vs on-clamp robotic partial nephrectomy: Perioperative, functional and oncological outcomes from a propensity-score matching between two high-volume centers. Eur J Surg Oncol 45:1232–1237. https://doi.org/10.1016/j.ejso.2018.12.005

    Article  PubMed  Google Scholar 

  22. Pierquet G, Zongo D, Robert G, Pasticier G, Maurice-Tison S, Bensadoun H et al (2016) Partial nephrectomy on solitary kidney: Renal function outcome and predictive factors of impairment. Prog Urol 26:34–40. https://doi.org/10.1016/j.purol.2015.09.018

    Article  CAS  PubMed  Google Scholar 

  23. Lane BR, Russo P, Uzzo RG, Hernandez AV, Boorjian SA, Thompson RH et al (2011) Comparison of Cold and Warm Ischemia During Partial Nephrectomy in 660 Solitary Kidneys Reveals Predominant Role of Nonmodifiable Factors in Determining Ultimate Renal Function. J Urol 185:421–427. https://doi.org/10.1016/j.juro.2010.09.131

    Article  PubMed  Google Scholar 

  24. Thompson RH, Lane BR, Lohse CM, Leibovich BC, Fergany A, Frank I et al (2010) Comparison of Warm Ischemia Versus No Ischemia During Partial Nephrectomy on a Solitary Kidney. Eur Urol 58:331–336. https://doi.org/10.1016/j.eururo.2010.05.048

    Article  PubMed  Google Scholar 

  25. Tanagho YS, Kaouk JH, Allaf ME, Rogers CG, Stifelman MD, Kaczmarek BF et al (2013) Perioperative Complications of Robot-assisted Partial Nephrectomy: Analysis of 886 Patients at 5 United States Centers. Urology 81:573–580. https://doi.org/10.1016/j.urology.2012.10.067

    Article  PubMed  Google Scholar 

  26. Khanna A, Campbell SC, Murthy PB, Ericson KJ, Nyame YA, Abouassaly R (2020) Unplanned Conversion from Minimally Invasive to Open Kidney Surgery: The Impact of Robotics. J Endourol. https://doi.org/10.1089/end.2020.0357

    Article  PubMed  Google Scholar 

  27. Arora S, Abaza R, Adshead JM, Ahlawat RK, Challacombe BJ, Dasgupta P et al (2018) ‘Trifecta’ outcomes of robot-assisted partial nephrectomy in solitary kidney: a Vattikuti Collective Quality Initiative (VCQI) database analysis. BJU Int 121:119–123. https://doi.org/10.1111/bju.13967

    Article  CAS  PubMed  Google Scholar 

  28. Hung AJ, Cai J, Simmons MN, Gill IS (2013) “Trifecta” in partial nephrectomy. J Urol 189:36–42. https://doi.org/10.1016/j.juro.2012.09.042

    Article  PubMed  Google Scholar 

  29. Choi JE, You JH, Kim DK, Rha KH, Lee SH (2015) Comparison of perioperative outcomes between robotic and laparoscopic partial nephrectomy: a systematic review and meta-analysis. Eur Urol 67:891–901. https://doi.org/10.1016/j.eururo.2014.12.028

    Article  PubMed  Google Scholar 

  30. Zargar H, Bhayani S, Allaf ME, Stifelman M, Rogers C, Larson J et al (2014) Comparison of Perioperative Outcomes of Robot-Assisted Partial Nephrectomy and Open Partial Nephrectomy in Patients with a Solitary Kidney. J Endourol 28:1224–1230. https://doi.org/10.1089/end.2014.0297

    Article  PubMed  Google Scholar 

  31. Hillyer SP, Bhayani SB, Allaf ME, Rogers CG, Stifelman MD, Tanagho Y et al (2013) Robotic Partial Nephrectomy for Solitary Kidney: A Multi-institutional Analysis. Urology 81:93–97. https://doi.org/10.1016/j.urology.2012.08.055

    Article  PubMed  Google Scholar 

  32. Gul Z, Blum KA, Paulucci DJ, Abaza R, Eun DD, Bhandari A et al (2018) A multi-institutional report of peri-operative and functional outcomes after robot-assisted partial nephrectomy in patients with a solitary kidney. J Robot Surg. https://doi.org/10.1007/s11701-018-0883-5

    Article  PubMed  Google Scholar 

  33. Lane BR, Novick AC, Babineau D, Fergany AF, Kaouk JH, Gill IS (2008) Comparison of Laparoscopic and Open Partial Nephrectomy for Tumor in a Solitary Kidney. J Urol 179:847–852. https://doi.org/10.1016/j.juro.2007.10.050

    Article  PubMed  Google Scholar 

  34. Panumatrassamee K, Autorino R, Laydner H, Hillyer S, Khalifeh A, Kassab A et al (2013) Robotic versus laparoscopic partial nephrectomy for tumor in a solitary kidney: A single institution comparative analysis: RPN vs LPN in solitary kidney. Int J Urol 20:484–491. https://doi.org/10.1111/j.1442-2042.2012.03205.x

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Urology Department of Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015, Paris, France

    Ygal Benichou & François Audenet

  2. Urology Department of Rennes, Rennes, France

    Karim Bensalah

  3. Urology Department of La Pitié-Salpétrière, Paris, France

    Morgan Roupret

  4. Urology Department of Lyon, Lyon, France

    Philippe Paparel

  5. Urology Department of Le Kremlin-Bicètre, Le Kremlin Bicetre, France

    Cedric Lebacle

  6. Urology Department of Tours, Tours, France

    Franck Bruyère

  7. Urology Department of La Croix Du Sud, Pierre-Bénite, France

    Jean-Baptiste Beauval

  8. Urology Department of Lille, Paris, France

    Arnauld Villers

  9. Urology Department of Strasbourg, Strasbourg, France

    Hervé Lang

  10. Urology Department of St. Joseph, Paris, France

    Xavier Durand

  11. Urology Department of Angers, Angers Cedex 9, France

    Pierre Bigot

  12. Urology Department of Grenoble, Grenoble Cedex 9, France

    Jean Alexandre Long

  13. Urology Department of Henri-Mondor, Creteil, France

    Cécile Champy

  14. Urology Department of Bichat, Paris, France

    Alexandre Lavolle

  15. Urology Department of Bordeaux, Bordeaux, France

    Jean Christophe Bernhard & Eric Alezra

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  1. Ygal Benichou
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Contributions

YB: protocol development, data management, data analysis, manuscript writing. FA: data collection, data analysis. KB, MR, PP, CL, FB, JBB, AV, HL, XD, PB, JAL, CC: data collection. AL: data management; data analysis. JCB: protocol development; data collection, manuscript editing. EA: protocol development; data management, data analysis, manuscript writing, manuscript editing.

Corresponding author

Correspondence to Ygal Benichou.

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Conflict of interest

KB, PhP, and JCB are proctors for Intuitive Surgical. The other authors have no relevant financial or non-financial interests to disclose.

Informed written consent

Informed written consent was collected for each patient which were all included into the French kidney cancer network database UroCCR (CNIL-DR 2013-206; NCT number 03293563).

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Benichou, Y., Audenet, F., Bensalah, K. et al. Partial nephrectomy in solitary kidneys: comparison between open surgery and robotic-assisted laparoscopy on perioperative and functional outcomes (UroCCR-54 study). World J Urol 41, 315–324 (2023). https://doi.org/10.1007/s00345-022-04026-y

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