Robot-assisted partial nephrectomy in cystic tumours: analysis of the Vattikuti Global Quality Initiative in Robotic Urologic Surgery (GQI-RUS) database.
Novara G, La Falce S, Abaza R, Adshead J, Ahlawat R, Buffi NM, Challacombe B, Dasgupta P, Moon DA, Parekh D, Porpiglia F, Rawal S, Rogers C, Volpe A, Bhandari M, and Mottrie A. Robot-assisted partial nephrectomy in cystic tumors: analysis of the Vattikuti Global Quality Initiative in Robotic Urologic Surgery (GQI-RUS) database. BJU Int 2016; 117(4):642-647.
OBJECTIVE: To evaluate the outcomes of robot-assisted partial nephrectomy (RAPN) in cystic tumours, analysing a large, multi-institutional, retrospective series of RAPN, as limited data are available about the outcome of RAPN in cystic tumours.
PATIENTS AND METHODS: We evaluated 465 patients who received RAPN for either cystic or solid tumours from 2010 to 2013 and included in the multi-institutional, retrospective Vattikuti Global Quality Initiative in Robotic Urologic Surgery (GQI-RUS) database. Univariable and multivariable linear and logistic regression models addressed the association of cystic tumours with perioperative outcomes.
RESULTS: In all, 54 (12%) tumours were cystic. Cystic tumours were associated with significantly lower operative time (t -3.9; P < 0.001), once adjusted for the effect of covariates, whereas blood loss and warm ischaemia time were similar. Postoperative any grade complications were recorded in 66 solid (16%) and nine cystic (17%) tumours (P = 0.08). In multivariable analysis, cystic tumours were not associated with a significantly lower risk of any grade postoperative complications [odds ratio (OR) 0.9; P = 0.8]. Similarly, presence of tumours with cystic features was not associated with a significantly different risk of high-grade postoperative complications (OR 2.2; P = 0.1). Prevalence of cancer histology and positive surgical margin rates were similar in cystic and solid tumours. Cystic tumours were not associated with significantly different postoperative estimated glomerular filtration rate (t 0.4; P = 0.7), once adjusted for the effect of covariates.
CONCLUSIONS: RAPN can be performed in cystic renal tumours with perioperative, pathological, and functional outcomes similar to those achievable in solid tumours.
Medical Subject Headings
Aged; Female; Glomerular Filtration Rate; Humans; Kidney Diseases, Cystic; Kidney Neoplasms; Male; Middle Aged; Nephrectomy; Operative Time; Quality of Health Care; Retrospective Studies; Robotic Surgical Procedures; Tomography, X-Ray Computed; Tumor Burden