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Comparative Study
. 2024 Oct;29(10):1548-1556.
doi: 10.1007/s10147-024-02599-9. Epub 2024 Aug 7.

Efficacy of robot-assisted partial nephrectomy compared to conventional laparoscopic partial nephrectomy for completely endophytic renal tumor: a multicenter, prospective study

Nobuyuki Hinata  1   2 , Sae Murakami  3 , Yuzo Nakano  4 , Isao Hara  5 , Tsunenori Kondo  6 , Shuzo Hamamoto  7 , Ryoichi Shiroki  8 , Jun Nagayama  9 , Mutsushi Kawakita  10 , Masatoshi Eto  11 , Osamu Ukimura  12 , Atsushi Takenaka  13 , Toshio Takagi  14 , Masaki Shimbo  15 , Haruhito Azuma  16 , Tetsuya Yoshida  17 , Junya Furukawa  18 , Naoki Kawamorita  19 , Masato Fujisawa  4
Affiliations
Comparative Study

Efficacy of robot-assisted partial nephrectomy compared to conventional laparoscopic partial nephrectomy for completely endophytic renal tumor: a multicenter, prospective study

Nobuyuki Hinata et al. Int J Clin Oncol. 2024 Oct.

Abstract

Background: This study aimed to compare the efficacy of robot-assisted partial nephrectomy for completely endophytic renal tumors with the reported outcomes of conventional laparoscopic partial nephrectomy and investigate the transition of renal function after robot-assisted partial nephrectomy.

Methods: We conducted a prospective, multicenter, single-arm, open-label trial across 17 academic centers in Japan. Patients with endophytic renal tumors classified as cT1, cN0, cM0 were included and underwent robot-assisted partial nephrectomy. We defined two primary outcomes to assess functional and oncological aspects of the procedure, which were represented by the warm ischemic time and positive surgical margin, respectively. Comparisons were made using control values previously reported in laparoscopic partial nephrectomy studies. In the historical control group, the warm ischemia time was 25.2, and the positive surgical margin was 13%.

Results: Our per-protocol analysis included 98 participants. The mean warm ischemic time was 20.3 min (99% confidence interval 18.3-22.3; p < 0.0001 vs. 25.2). None of the 98 participants had a positive surgical margin (99% confidence interval 0-5.3%; p < 0.0001 vs. 13.0%). The renal function ratio of eGFR before and after protocol treatment multiplied by splits was 0.70 (95% confidence interval: 0.66-0.75). Factors such as preoperative eGFR, resected weight, and warm ischemic time influenced the functional loss of the partially nephrectomized kidney after robot-assisted partial nephrectomy.

Conclusions: Robot-assisted partial nephrectomy for completely endophytic renal tumors offers a shorter warm ischemia time and comparable positive surgical margin rate compared with conventional laparoscopic partial nephrectomy.

Keywords: Carcinoma; Nephrectomy; Renal cell; Renal insufficiency; Robotic surgical procedures.

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Conflict of interest statement

No author has any conflict of interest.

Figures

Fig. 1
Fig. 1
Trial flow chart
Fig. 2
Fig. 2
Mean WIT with the 95%CI of four historical studies and the present study. The dotted error bar is the 99%CI of the present study. A reference line at 25.2 min is included, representing the average WIT across the four historical studies. This line serves as a benchmark against which the WITs of the individual studies and our current trial data are compared
Fig. 3
Fig. 3
A The distribution of preoperative and postoperative (POD180) split eGFR (mL/min 1.73 m2) of operated kidneys. B Kaplan–Meier curve of CKD progression-free survival in RAPN. CKD progression is defined as the advancement of CKD by at least one stage in the CKD classification. The gray-shaded area represents the 95% CI
See this image and copyright information in PMC

References

    1. Ljungberg B, Albiges L, Abu-Ghanem Y et al (2019) European association of urology guidelines on renal cell carcinoma: the 2019 update. Eur Urol 75:799–810 - DOI - PubMed
    1. Kutikov A, Uzzo RG (2009) The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182:844–853 - DOI - PubMed
    1. Ficarra V, Novara G, Secco S et al (2009) Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol 56:786–793 - DOI - PubMed
    1. Thompson RH, Lane BR, Lohse CM et al (2010) Every minute counts when the renal hilum is clamped during partial nephrectomy. Eur Urol 58:340–345 - DOI - PubMed
    1. Funahashi Y, Hattori R, Yamamoto T et al (2012) Effect of warm ischemia on renal function during partial nephrectomy: assessment with new 99mTc-mercaptoacetyltriglycine scintigraphy parameter. Urology 79:160–164 - DOI - PubMed