'Trifecta' outcomes of robot-assisted partial nephrectomy in solitary kidney: a Vattikuti Collective Quality Initiative (VCQI) database analysis.
Arora S, Abaza R, Adshead JM, Ahlawat RK, Challacombe BJ, Dasgupta P, Gandaglia G, Moon DA, Yuvaraja TB, Capitanio U, Larcher A, Porpiglia F, Porter JR, Mottrie A, Bhandari M, and Rogers C. Trifecta outcomes of robot-assisted partial nephrectomy in solitary kidney: A vattikuti collective quality initiative (vcqi) database analysis. BJU Int 2017; 121(1):119-123.
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) of <20 min, 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 m2 (11.01%).
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 of <20 min, and low operative and perioperative morbidity.
Medical Subject Headings
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