Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jul 20;57(3):348-355.
doi: 10.2478/raon-2023-0031. eCollection 2023 Sep 1.

Does tumor rupture during robot-assisted partial nephrectomy have an impact on mid-term tumor recurrences?

Simon Hawlina  1   2 , Kosta Cerovic  1 , Andraz Kondza  1 , Peter Popovic  3   4 , Jure Bizjak  1 , Tomaz Smrkolj  1   2
Affiliations

Does tumor rupture during robot-assisted partial nephrectomy have an impact on mid-term tumor recurrences?

Simon Hawlina et al. Radiol Oncol. .

Abstract

Background: Intraoperative kidney tumor rupture (TR) can occur during robot-assisted partial nephrectomy (RAPN) in daily clinical practice, but there are no solid guidelines on the management and implications of it. The purpose of the study was to investigate the impact of TR on tumor recurrences, what a surgeon should do if this adverse event occurs, and how to avoid it.

Patients and methods: We retrospectively analyzed the first 100 patients who underwent RAPN at University Medical Centre Ljubljana, between 2018 and 2021. Patients were stratified into 2 groups (TR and no-TR) and were compared according to patient, tumor, pathologic, perioperative and postoperative characteristics and tumor recurrences, using the Mann-Whitney U test and chi-squared test.

Results: Of the 100 patients, 14 had TR (14%); this occurred in tumors with higher RENAL nephrometry scores (P = 0.028) and mostly with papillary renal cell carcinomas (P = 0.043). Median warm ischemia time was longer for the TR group (22 vs. 15 min, P = 0.026). In terms of studied outcomes, there were no cases of local or distant recurrence after a median observation time of 39 months (interquartile range, 31-47 months) in both groups. We observed positive surgical margins on the final oncologic report in one case in the no-TR group.

Conclusions: Tumor rupture during RAPN seems to be of no mid-term oncologic importance. According to presented results, we would recommend surgeons to proceed with tumor resection if this event occurs and abstain from conversion to radical nephrectomy or open partial nephrectomy. However, more similar cases should be studied to make more solid conclusions.

Keywords: enucleation; renal cell carcinoma; robot-assisted partial nephrectomy; tumor recurrence; tumor rupture; warm ischemia time.

PubMed Disclaimer

Figures

FIGURE 1.
FIGURE 1.
(A) Example of tumor rupture during enucleation of a renal tumor. (B) Tumor bed after the tumor was completely removed from healthy kidney parenchyma (intraoperative snapshots).
See this image and copyright information in PMC

References

    1. Ljungberg B, Albiges L, Abu-Ghanem Y, Bedke J, Capitanio U, Dabestani S. et al. European Association of Urology Guidelines on Renal Cell Carcinoma: the 2022 update. Eur Urol. 2022;82:399–410. doi: 10.1016/J.EURURO.2022.03.006. - DOI - PubMed
    1. Minervini A, Campi R, Di Maida F, Mari A, Montagnani I, Tellini R. et al. Tumor-parenchyma interface and long-term oncologic outcomes after robotic tumor enucleation for sporadic renal cell carcinoma. Urol Oncol. 2018;36:527.e1–e11. doi: 10.1016/j.urolonc.2018.08.014. - DOI - PubMed
    1. Minervini A, Vittori G, Lapini A, Tuccio A, Siena G, Serni S. et al. Morbidity of tumour enucleation for renal cell carcinoma (RCC): results of a single-centre prospective study. BJU Int. 2012;109:372–7. doi: 10.1111/J.1464-410X.2011.10360.X. - DOI - PubMed
    1. Minervini A, Serni S, Tuccio A, Raspollini MR, Di Cristofano C, Siena G. et al. Local recurrence after tumour enucleation for renal cell carcinoma with no ablation of the tumour bed: results of a prospective single-centre study. BJU Int. 2011;107:1394–9. doi: 10.1111/J.1464-410X.2010.09949.X. - DOI - PubMed
    1. Khene ZE, Peyronnet B, Pradère B, Robert C, Goujon A, Kammerer-Jacquet SF. et al. Does tumour effraction during robotic partial nephrectomy have any impact on recurrence? Int J Clin Oncol. 2019;24:87–93. doi: 10.1007/S10147-018-1331-2. - DOI - PubMed