Outcomes in robotic-assisted partial nephrectomy for imperative versus elective indications
Tan J, Sathianathen N, Cumberbatch M, Dasgupta P, Mottrie A, Abaza R, Rha K, Yuvaraja T, Parekh D, Capitanio U, Ahlawat R, Rawal S, Buffi N, Sivaraman A, Maes K, Gautham G, Porpiglia F, Turkeri L, Bhandari M, Challacombe B, Porter J, Rogers C, Moon D. Outcomes in robotic-assisted partial nephrectomy for imperative versus elective indications. BJU international 2021; .
OBJECTIVES: To assess and compare perioperative outcomes of patients undergoing robotic-assisted partial nephrectomy (RAPN) for imperative versus elective indications.
PATIENT AND METHODS: We retrospectively reviewed a multinational database of 3,802 adult patients who underwent RAPN for elective and imperative indications. Laparoscopic or open PN were excluded. Baseline data for age, gender, BMI, ASA and PADUA score were examined. Patients undergoing RAPN for an imperative indication were matched to those having surgery for an elective indication using propensity scores in a 1:3 ratio. Primary outcomes included organ ischaemic time, operative time, estimated blood loss, rate of blood transfusions, Clavien-Dindo complications, conversion to radical nephrectomy (RN) and positive surgical margins.
RESULTS: After propensity score matching for baseline variables, a total of 304 patients (76 imperative vs 228 non-imperative indications) were included in the final analysis. No significant differences were found between groups for ischaemic time (19.9min vs 19.8min, p=0.94), operative time (186min vs 180min, p=0.55), estimated blood loss (217mL vs 190mL, p=0.43), rate of blood transfusions (2.7% vs 3.7%, p=0.51), or Clavien-Dindo complications (p=0.31). A 38.6% (SD 47.9) decrease in Day 1 post-operative eGFR was seen in the imperative indication group and a 11.3% (SD 45.1) decrease in eGFR seen in the elective indications group, p<0.005; no recorded cases of permanent or temporary dialysis were seen. There were no conversions to RN in the imperative group and 5.6% (n=7) conversions in the non-imperative group (p=0.69). Positive surgical margins were seen in 1.4% (1/76) of the imperative group and 3.3% of the non-imperative group (7/228), p=0.69.
CONCLUSION: RAPN is feasible and safe for imperative indications and demonstrates similar outcomes to elective indications.
ePub ahead of print