Does tumour effraction during robotic partial nephrectomy have any impact on recurrence?

Abstract

Objective: To evaluate the impact of accidental surgical incision into the tumour (ASIT) on oncological outcomes in patients undergoing RPN for a malignant tumour.

Materials and methods: A retrospective review of our prospectively maintained database was performed to identify all patients who underwent RPN for a localized RCC between June 2010 and July 2016. We stratified our cohort into two groups according to the presence of an ASIT. Perioperative data were compared between the two groups. Logistic regression analyses were used to assess the variables associated with ASIT. Recurrence-free survival was estimated using the Kaplan-Meier method and compared between groups with the log-rank test.

Results: A total of 234 patients were identified. 32 (14%) ASIT were observed. Patients' characteristics were similar in the two groups. Most of intraoperative outcomes were comparable between the two groups, but patients in the ASIT group had greater EBL (475 vs. 300 mL; p = 0.01). In multivariate analysis, tumour size (p = 0.02), RENAL score (p = 0.02), EBL (p = 0.05) and low surgeon experience (p = 0.03) were all predictive factors of ASIT. 15 (6%) of recurrences were observed over a median follow-up of 36 months. There was no difference in recurrence-free survival between the two groups (p = 0.57).

Conclusions: In our experience, accidental surgical incision into the tumour during RPN was a common event that did not appear to compromise oncological outcome.

Keywords: Complications; Partial nephrectomy; Recurrence; Robotic surgical procedures; Survival.