Category: Laparoscopic/ Robotic: Other

MP16-7 - Robotic-assisted partial nephrectomy for T1b and T2 renal tumors: Initial experience in Puerto Rico

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective :

As experience with robotic assisted partial nephrectomy (RAPN) for the management of small renal masses (< 4 cm) has increased some centers have expanded its indication for larger and more complex tumors. We report our experience with RAPN for renal tumors > 4 to ≤7cm (T1b) and >7cm (T2).

Methods :

Of 252 RAPN performed by a single surgeon (RC) between 10/2012 and 10/2017. Fifty two were performed for a clinical stage T1b and T2 tumors. Perioperative and oncological outcomes were evaluated.

Results :

Mean age was 58.1 years (Range from 31 to 77), body mass index (BMI) was 30.4 kg/m2 (Range from 20.9 to 42.4) and ASA Score was 2.5 (Range from 1 to 3). Mean tumor diameter was 5.4 cm. (Range from 4.1 to 9.2). Tumor complexity was divided according to the R.E.N.A.L score: low (4-6): 3 (5.8%), moderate (7-9): 28 (53.8%) and severe (10-12): 21 (40.4%).Average total operative time was 161.5 min (Range from 105 to 262), warm ischemia time was 24.8 min (Range from 8 to 42), estimated blood loss was 121.2 ml (Range from 40 to 360) and length of stay was 1.2 days (Range from 1 to 2).Pathology revealed renal cell carcinoma: 42 (80.8%), benign cyst: 6 (11.5%), angiomyolipoma: 2 (3.8%) and oncocytoma: 2 (3.8%). 73.5% require repaired of the collecting system. There was one intraoperative bleeding controlled with re-clamping and suturing. There were no transfusions. There were no positive surgical margins. There was no urinary leakage.No patient progressed to dialysis postoperatively and there was no significant difference between preoperative and postoperative serum creatinine or estimated glomerular filtration rate using the Modification of Diet in Renal Disease equation (MDRD) (p=0.2)Of 34 patients, 55.9% had at least a follow-up of ≥1 year and 29.4% had a follow-up of ≤6 months. No patients have recurred to date. The mean follow up was 21.6 months.

Conclusions : RAPN represents a technically challenging but a safe and valid alternative to open partial nephrectomy in select patients with renal tumors > 4cm resulting in excellent functional and oncological outcomes

Braulio Cuesta-Camunas

Medical student
University of Puerto Rico
Bayamon, Not Applicable, Puerto Rico

Ronald G. Cadillo-Chavez

Assistant professor
University of Puerto Rico
Guaynabo, Not Applicable, Puerto Rico

Ronald Cadillo-Chavez MD
Assistant Profesor University of Puerto Rico
Robotic Urology & Oncology Institute
Robotic Urologic Oncology and Reconstructive Surgery.

Hector Lopez-Huertas

Assistant profesor
University of Puerto Rico
San Juan, Not Applicable, Puerto Rico