Category: Laparoscopic/ Robotic: Other

MP25-10 - The evolution of robotic assisted partial nephrectomy and Improving outcomes in advanced tumours: A prospective Case series

Sun, Sep 23
10:00 AM - 12:00 PM

Introduction & Objective :

Robotic assisted partial nephrectomy (RAPN) is increasingly the predominant method of treating small renal masses with recent studies demonstrating equivalent short-term oncological outcomes with reduced peri-operative morbidity. Here we analyze our results looking at casemix with disease parameters and pertinent outcomes of both operative and oncological variables. 

Methods :

We reviewed our prospectively collated database of all RAPN performed sequentially by one surgeon in our unit between 2010 and 2017. Cases were divided into 3 case cohorts. Variables included age, BMI, ASA, estimated GFR (eGFR), tumour size, PADUA score, operative time, blood loss, warm ischemic time (WIT) and length of stay (LOS). The renal Trifecta was defined as WIT ≤25 minutes, negative surgical margins and absence Clavien ≥3a complications. Pentafecta was defined as achievement of Trifecta with addition of over 90% eGFR preservation and no chronic kidney disease (CKD) stage upgrade. Results were analysed using non-parametric analysis.

Results :

273 cases were performed with clinical features below. The parameters for each of the 3 cohorts were statistically analysed using Wilcoxon-sign Rank test (numerical values) and chi-squared test (proportions).  Patient demographics were statistically similar in all 3 cohorts, with the exception of ASA 3, which was highest in Cohort 3. There was an increase in BMI from group 1 to 3, and a statistically significant increase in size of the tumour between group 1 and 3 (p value = 0.002). The median PADUA was also increased between group 1 and 3 (p-value = 0.006). There was a small statistically increase in blood loss between groups 1 and 3, but clinically insignificant (150ml vs 200ml). There was a decrease in Operative time, and a statistically significant decrease in length of stay (p-value<0.001). 
There was a steady increase in patient and tumour complexity while our Trifecta and Pentafecta rates significantly and steadily increased over the cohorts. The trifecta rates rose between the groups from 93% to 97%, although not significant statistically. While the aim of the study was to keep the pentafecta rates constant between the groups, the pentafecta rates rose between the groups from 71% to 88% (p-value=0.005).  

Conclusions :

Despite performing RAPN on more comorbid patients with greater BMI who have larger more complex lesions; trifecta and pentafecta rates have climbed. LOS is shorter without a concomitant increase in WIT. In our experience this affirms the evolution of RAPN utility in the more complex patient and more complex pathology.

Akshaya Rajangam

Medical Student
King's College London
London, England, United Kingdom

Akshaya Rajangam BSc (Hons) is a fourth year medical student in King’s College London. She graduated with an iBSc (Hons) in Anatomy, Human Biology and Developmental Sciences in 2017 and was awarded the Alfred Hughes Memorial Prize. Her focus lies in robotic urological surgery, with a publication on BJU and several presentations, including RSM Winter Papers Meeting 2016 and the best surgical presentation at the Alcock Society meeting 2017. She has also presented at the European Rhinology Congress 2018. She is currently the Vice President of King's College London Surgical Society and the Treasurer of the Future Surgeons Forum, an initiative by the Royal College of Surgeons (England).

Nicolo De Luyk

Department of Urology
Guy's and St Thomas' Hospitals Trust
London, England, United Kingdom

Benjamin Challacombe

Consultant Urological Surgeon
Guy's and St. Thomas' Hospitals, London
London, England, United Kingdom

Benjamin Namdarian

Consultant Urologist
Guy's and St Thomas Foundation Trust
London, England, United Kingdom