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Operative and oncological outcomes of salvage robotic radical and partial nephrectomy: a multicenter experience

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Abstract

We aim to describe the perioperative and oncological outcomes for salvage robotic partial nephrectomy (sRPN) and salvage robotic radical nephrectomy (sRRN). Using a prospectively maintained multi-institutional database, we compared baseline clinical characteristics and perioperative and postoperative outcomes, including pathological stage, tumor histology, operative time, ischemia time, estimated blood loss (EBL), length of stay (LOS), postoperative complication rate, recurrence rate, and mortality. We identified a total of 58 patients who had undergone robotic salvage surgery for a recurrent renal mass, of which 22 (38%) had sRRN and 36 (62%) had sRPN. Ischemia time for sRPN was 14 min. The median EBL was 100 mL in both groups (p = 0.581). One intraoperative complication occurred during sRRN, while three occurred during sRPN cases (p = 1.000). The median LOS was 2 days for sRRN and 1 day for sRPN (p = 0.039). Postoperatively, one major complication occurred after sRRN and two after sRPN (p = 1.000). The recurrence reported after sRRN was 5% and 3% after sRPN. Among the patients who underwent sRRN, the two most prevalent stages were pT1a (27%) and pT3a (27%). Similarly, the two most prevalent stages in sRPN patients were pT1a (69%) and pT3a (6%). sRRN and sRPN have similar operative and perioperative outcomes. sRPN is a safe and feasible procedure when performed by experienced surgeons. Future studies on large cohorts are essential to better characterize the importance and benefit of salvage partial nephrectomies.

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References

  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A et al (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71(3):209–249

    Article  PubMed  Google Scholar 

  2. Pichler M, Hutterer GC, Chromecki TF, Jesche J, Kampel-Kettner K, Pummer K et al (2012) Renal cell carcinoma stage migration in a single European centre over 25 years: effects on 5- and 10-year metastasis-free survival. Int Urol Nephrol 44(4):997–1004

    Article  PubMed  Google Scholar 

  3. Sun M, Thuret R, Abdollah F, Lughezzani G, Schmitges J, Tian Z et al (2011) Age-adjusted incidence, mortality, and survival rates of stage-specific renal cell carcinoma in North America: a trend analysis. Eur Urol 59(1):135–141

    Article  PubMed  Google Scholar 

  4. Campbell S, Uzzo RG, Allaf ME, Bass EB, Cadeddu JA, Chang A et al (2017) Renal mass and localized renal cancer: AUA guideline. J Urol 198(3):520–529

    Article  PubMed  Google Scholar 

  5. Mir MC, Derweesh I, Porpiglia F, Zargar H, Mottrie AAR (2017) Partial nephrectomy versus radical nephrectomy for clinical T1b and T2 renal tumors: a systematic review and meta-analysis of comparative studies. Eur Urol 71(4):606–617

    Article  PubMed  Google Scholar 

  6. Tsai SH, Tseng PT, Sherer BA, Lai YC, Lin PY, Wu CK et al (2019) Open versus robotic partial nephrectomy: systematic review and meta-analysis of contemporary studies. Int J Med Robot 15(1):e1963

    Article  PubMed  Google Scholar 

  7. Campbell SC, Novick AC, Belldegrun A, Blute ML, Chow GK, Derweesh IH et al (2009) Guideline for management of the clinical T1 renal mass. J Urol 182(4):1271–1279

    Article  PubMed  Google Scholar 

  8. Speed JM, Trinh QD, Choueiri TKSM (2017) Recurrence in localized renal cell carcinoma: a systematic review of contemporary data. Curr Urol Rep 18(2):15

    Article  PubMed  Google Scholar 

  9. Rabinovitch RA, Zelefsky MJ, Gaynor JJFZ (1994) Patterns of failure following surgical resection of renal cell carcinoma: implications for adjuvant local and systemic therapy. J Clin Oncol 12(1):206–212

    Article  CAS  PubMed  Google Scholar 

  10. Parienty RA, Richard F, Pradel JVG (1984) Local recurrence after nephrectomy for primary renal cancer: computerized tomography recognition. J Urol 132(2):246–249

    Article  CAS  PubMed  Google Scholar 

  11. Sease WCBJ (1986) Computerized tomography in the early postoperative management of renal cell carcinoma. J Urol 136(4):792–794

    Article  CAS  PubMed  Google Scholar 

  12. Janzen NK, Kim HL, Figlin RABA (2003) Surveillance after radical or partial nephrectomy for localized renal cell carcinoma and management of recurrent disease. Urol Clin N Am 30(4):843–852

    Article  Google Scholar 

  13. Margulis V, McDonald M, Tamboli P, Swanson DAWC (2009) Predictors of oncological outcome after resection of locally recurrent renal cell carcinoma. J Urol 181(5):2044–2051

    Article  PubMed  Google Scholar 

  14. Pierorazio PM, Johnson MH, Patel HD, Sozio SM, Sharma R, Iyoha E, Bass EBAM (2016) Management of renal masses and localized renal cancer: systematic review and meta-analysis. J Urol 196(4):989–999

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kriegmair MC, Bertolo R, Karakiewicz PI, Leibovich BC, Ljungberg B, Mir MC et al (2018) Systematic review of the management of local kidney cancer relapse. Eur Urol Oncol 1(6):512–523

    Article  PubMed  Google Scholar 

  16. Abarzua-Cabezas FG, Sverrisson E, De La Cruz R, Spiess PE, Haddock PSW (2015) Oncological and functional outcomes of salvage renal surgery following failed primary intervention for renal cell carcinoma. Int Braz J Urol 41(1):147–154

    Article  PubMed  PubMed Central  Google Scholar 

  17. Patel HD, Pierorazio PM, Johnson MH, Sharma R, Iyoha E, Allaf ME, Bass EBSS (2017) Renal functional outcomes after surgery, ablation, and active surveillance of localized renal tumors: a systematic review and meta-analysis. Clin J Am Soc Nephrol 12(7):1057–1069

    Article  PubMed  PubMed Central  Google Scholar 

  18. Go AS, Chertow GM, Fan D, McCulloch CEHC (2004) Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 351(13):1296–1305

    Article  CAS  PubMed  Google Scholar 

  19. Bratslavsky GLW (2010) Long-term management of bilateral, multifocal, recurrent renal carcinoma. Nat Rev Urol 7(5):267–275

    Article  PubMed  PubMed Central  Google Scholar 

  20. Charlson M, Szatrowski TP, Peterson J (1994) GJV of a combined comorbidity index. Validation of a combined comorbidity index. J Clin Epidemiol 47(11):1245–1251

    Article  CAS  PubMed  Google Scholar 

  21. Andrew SL, Lesley AS, Christopher HS, Ya** LZ, Castro AFM III, Harold IF, John WK, Paul E, van Lente F, Tom GP, Josef C, CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612

    Article  Google Scholar 

  22. Dindo D, Demartines NCP (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  PubMed Central  Google Scholar 

  23. Pierorazio PM, Johnson MH, Patel HD, Sozio SM, Sharma R, Iyoha E, Bass EB, Allaf ME (2016) Management of renal masses and localized renal cancer. Agency for Healthcare Research and Quality (US), Rockville

  24. Campbell S, Uzzo RG, Allaf ME, Bass EB, Cadeddu JA, Chang A et al (2017) Renal mass and localized renal cancer. Am Urol Assoc. https://doi.org/10.1016/j.juro.2017.04.100

    Article  Google Scholar 

  25. Master VA, Gottschalk AR, Kane C et al (2005) Management of isolated renal fossa recurrence following radical nephrectomy. J Urol 174:473–477

    Article  PubMed  Google Scholar 

  26. Marc G, Fabrice D, François R, Xavier Cathelineau GV (2004) The surgical management of recurrent urological malignancies after primary ablative therapy. Bull Cancer 91(11):875–881

    Google Scholar 

  27. Itano NB, Blute ML, Spotts BZH (2000) Outcome of isolated renal cell carcinoma fossa recurrence after nephrectomy. J Urol 164(2):322–325

    Article  CAS  PubMed  Google Scholar 

  28. Montie JE (1994) Follow-up after partial or total nephrectomy for renal cell carcinoma. Urol Clin N Am 21(4):589–592

    Article  CAS  Google Scholar 

  29. Campbell SC (1994) Management of local recurrence following radical nephrectomy or partial nephrectomy. Urol Clin N Am. https://doi.org/10.1016/S0094-0143(21)00635-2

    Article  Google Scholar 

  30. Galiano M, Dugardin F, Rozet F, Cathelineau X, Vallancien G (2004) The surgical management of recurrent urological malignancies after primary ablative therapy. Bull Cancer 91(11):875–881

    PubMed  Google Scholar 

  31. Magera JS, Frank I, Lohse CM et al (2008) Analysis of repeat nephron sparing surgery as a treatment option in patients with a solid mass in a renal remnant. J Urol 179:853–856

    Article  PubMed  Google Scholar 

  32. Johnson A, Sudarshan S, Liu J, Linehan WM, Pinto PABG (2008) Feasibility and outcomes of repeat partial nephrectomy. J Urol 180(1):89–93

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kowalczyk KJ, Hooper HB, Linehan WM, Pinto PA, Wood BJBG (2009) Partial nephrectomy after previous radio frequency ablation: the national cancer institute experience. KJ Urol 182(5):2158–2163

    Article  Google Scholar 

  34. Thomas AZ, Adibi M, Borregales LD et al (2015) Management of local retroperitoneal recurrence of renal cell carcinoma after radical nephrectomy. Surg J Urol 194(2):316–322

    Article  PubMed  Google Scholar 

  35. Nguyen CT, Lane BR, Kaouk JH, Hegarty N, Gill IS, Novick ACCS (2008) Surgical salvage of renal cell carcinoma recurrence after thermal ablative therapy. J Urol 180(1):104–109

    Article  PubMed  Google Scholar 

  36. Karam JA, Wood CG, Compton ZR, Rao P, Vikram R, Ahrar K et al (2015) Salvage surgery after energy ablation for renal masses. BJU Int 115(1):74–80

    Article  PubMed  Google Scholar 

  37. Jiménez JA, Zhang Z, Zhao J, Abouassaly R, Fergany A, Gong M et al (2016) Surgical salvage of thermal ablation failures for renal cell carcinoma. J Urol 195(3):594–600. https://doi.org/10.1016/j.juro.2015.09.078

    Article  PubMed  Google Scholar 

  38. Autorino R, Khalifeh A, Laydner H, Samarasekera D, Rizkala E, Eyraud R et al (2013) Repeat robot-assisted partial nephrectomy (RAPN): feasibility and early outcomes. BJU Int 111(5):767–772

    Article  PubMed  Google Scholar 

  39. Jain S, Yates JK, Munver R (2013) Robot-assisted laparoscopic partial nephrectomy for recurrent renal-cell carcinoma in patients previously treated with nephron-sparing surgery. J Endourol 27(3):309–312

    Article  PubMed  Google Scholar 

  40. Gurram S, Friedberg NA, Gordhan C, Li W, Ahdoot MA, Egan J et al (2021) Reoperative partial nephrectomy-does previous surgical footprint impact outcomes? J Urol 206(3):539–547

    Article  PubMed  PubMed Central  Google Scholar 

  41. Watson MJ, Sidana A, Diaz AW, Siddiqui MM, Hankins RA, Bratslavsky G et al (2016) Repeat robotic partial nephrectomy: characteristics, complications, and renal functional outcomes. J Endourol 30(11):1219–1226

    Article  PubMed  PubMed Central  Google Scholar 

  42. Ghandour R, Miranda AF, Singla N, Meng X, Enikeev D, Woldu S et al (2020) Feasibility and safety of robotic excision of ipsilateral retroperitoneal recurrence after nephrectomy for renal cell carcinoma. Urology 145:159–165. https://doi.org/10.1016/j.urology.2020.07.060

    Article  PubMed  Google Scholar 

  43. Martini A, Turri F, Barod R, Rocco B, Capitanio U, Briganti A et al (2021) Salvage robot-assisted renal surgery for local recurrence after surgical resection or renal mass ablation: classification, techniques, and clinical outcomes. Eur Urol 80(6):730–737

    Article  PubMed  Google Scholar 

  44. Berg WT, Rich CR, Badalato GM, Deibert CM, Wambi CO, Landman J et al (2012) The first assistant sparing technique robot-assisted partial nephrectomy decreases warm ischemia time while maintaining good perioperative outcomes. J Endourol 26(11):1448–1453

    Article  PubMed  Google Scholar 

  45. Meilika K, Beksac AT, Okhawere K, Dayal B, Ige O, Badani K (2020) Utilizing a standardized technique to reduce ischemia time in robotic partial nephrectomy for all tumor complexities. J Urol 203(4):90

    Article  Google Scholar 

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Author notes

  1. Kennedy E. Okhawere and Ralph Grauer contributed as co-first authors.

Authors and Affiliations

  1. Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA

    Kennedy E. Okhawere, Ralph Grauer, Laura Zuluaga, Kirolos N. Meilika, Burak Ucpinar, Alp Tuna Beksac, Shirin Razdan, Indu Saini, Chiya Abramowitz, Mani Menon & Ketan K. Badani

  2. Department of Urology, OhioHealth Dublin Methodist Hospital, Dublin, OH, USA

    Ronney Abaza

  3. Department of Urology, Lewis Katz School of Medicine Temple University, Philadelphia, PA, USA

    Daniel D. Eun

  4. Division of Urology, Mount Sinai Medical Center, Miami Beach, FL, USA

    Akshay Bhandari

  5. Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Ashok K. Hemal

  6. Department of Urology, Swedish Urology, Seattle, WA, USA

    James Porter

  7. Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA

    Michael D. Stifelman

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Contributions

KO and RG are co-authors, and the idea was conceived by KO and KB. Data collection and analysis were performed by KO, IS, BU, and CA. The first draft was written by KO and KM, and all authors commented on the draft version of the manuscript. The final version was reviewed and approved by all the authors.

Corresponding author

Correspondence to Ketan K. Badani.

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Conflict of interest

The authors have not disclosed any competing interests.

A competing interest

Dr. Ronney Abaza is a lecturer for Intuitive Surgical Inc. and VTI Inc. Dr. Michael Stifelman is on the scientific advisory board of Intuitive Surgery and has an educational agreement with Ethicon. James Porter: Intuitive Surgical—Speaker, Training, Ceevra—Advisory Board, Medtronic—Advisory Board, Johnson and Johnson—Consultant. Daniel D. Eun is a paid speaker and proctor and performs meeting activities for Intuitive Surgical, Consultant for Medtronic, and Founder and shareholder of Melzi Corp. The remaining authors declare that they have no relevant financial interest.

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Okhawere, K.E., Grauer, R., Zuluaga, L. et al. Operative and oncological outcomes of salvage robotic radical and partial nephrectomy: a multicenter experience. J Robotic Surg 17, 1579–1585 (2023). https://doi.org/10.1007/s11701-023-01538-6

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  • DOI: https://doi.org/10.1007/s11701-023-01538-6

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