Category: Laparoscopic/ Robotic: Other

MP16-6 - A propensity-score matched comparison of perioperative Outcomes of Robotic Partial Nephrectomy for cT1a < 2 versus > 2 cm renal masses

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

Introduction & Objective :

To perform a single center evaluation comparing the perioperative, pathological and functional outcomes of robotic partial nephrectomy (RPN) for T1a renal masses < 2 cm vs T1a renal masses > 2 cm.


Methods : Propensity score 1:1 matching of queried patients was performed from the institutional RPN database (January 2007 – January 2017) by age, sex, race, BMI, Charlson’s comorbidity Index, smoker status, diabetes, hypertension, hyperlipidemia, ASA score, eGFR, Chronic Kidney Disease stage and RENAL score. 524 patients were analyzed (262 < 2 cm vs 262 > 2 cm). Perioperative, pathological and functional outcomes were evaluated.


Results :

< 2 cm renal masses had significantly lower operative time, blood loss, ischemia time (14.3 + 9.58 vs 21.5 + 9.51 minutes, p < 0.001) and intraoperative transfusions (0 vs 2.7%, p = 0.015). Moreover, superior early renal functional outcome as assessed by eGFR at first postoperative day (83.1 + 21.3 vs 76.6 + 22.0, p = 0.001), higher percentage of parenchymal preservation (89.9 + 9.45 vs 83.6 + 8.20%, p < 0.001) and a trend towards a lower rate of postoperative complications (13.5 vs 19.5%, p = 0.080) were found. Higher percentage of malignancies was found in larger tumors (74.8 vs 85.9%, p = 0.002), but no difference in positive surgical margins was recorded.


Conclusions : RPN tends to be a low morbidity treatment modality for renal masses < 2 cm. Although active surveillance is a common option for such tumors, RPN remains an effective alternative for selected patients.

Riccardo Bertolo

MD
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
Turin, Piemonte, Italy

Riccardo Bertolo, MD
Research Fellow, Robotic Urology,
Cleveland Clinic, Cleveland, OH, USA
PhD Candidate, Bioengineering in Medical/Surgical Sciences
Turin Politechnic, Italy

Juan Garisto

MD
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
Cleveland, Ohio

Juan Garisto, MD is an Advanced Laparoscopy & Robotics clinical fellow at Cleveland Clinic, Cleveland, OH, United States under the mentorship of Dr. Jihad Kaouk. He completed a Society of Urologic Oncology fellowship at the University of Toronto and did his urology residency training at Complejo Hospitalario Dr. A.A.Madrid in Panama City, Panama.

His current research interest in single port surgery and multidisciplinary management of urologic malignancies, in particular kidney and bladder cancer.

Julien Dagenais

MD
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
Cleveland, Ohio

Daniel Sagalovich

MD
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
Cleveland, Ohio

Jose Agudelo

MD
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
Cleveland, Ohio

Robert Stein

MD
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
Cleveland, Ohio

Khaled Fareed

Assistant Professor
Cleveland Clinic
Cleveland, Ohio

Khaled Fareed, MD
Assistant Professor of Urology, Lerner College of Medicine at Case Western Reserve University and Staff Urologist at Glickman Urological & Kidney Institiue at Cleveland Clinic
Graduated from Assiut University Medical School, Egypt in 1994, completed 2 years residency training in Assiut University Hospital. finished 2 years Research fellowship at the University of Texas, Southwestern Medical Center, and Residency training in urology at the same center. joined Cleveland Clinic in 2007 and been on staff. interests in EndoUrology, Advanced laparoscopy, image-guided Therapy, Robotics and BPH, Mens voiding dysfunction.

Tianming Gao

PhD
Quantitiative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
Cleveland, Ohio

Amr Fergany

MD
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
Cleveland, Ohio

Jihad Kaouk

Professor and Director, Center for Robotic and Image Guided Surgery Vice Chair, Surgical Innovations
Glickman Urologic Institute, Cleveland Clinic
Cleveland, Ohio

Jihad Kaouk, MD FACS

Dr. Jihad Kaouk is an American Board certified Urologist and Director, Center of Robotic and Image Guided Surgery at the Cleveland Clinic Glickman Urological Institute. He also serves as Professor of Surgery at the Cleveland Clinic Lerner College of Medicine, Vice Chair for Surgical Innovations and chair holder for the Zegarac-Pollock Endowed Chair in laparoscopic and robotic surgery.
In Innovations, he has performed several first ever done surgical procedures, including the first Robotic single port surgery through the belly button in 2008, the first completely transvaginal kidney removal in 2009, and the first robotic perineal prostatectomy in 2014 Dr. Kaouk holds 2 USA patents for medical devices used during partial nephrectomy and in robotic surgery.

Since 2005, Dr. Kaouk has served on committees at the national and local levels. From 2005-2008, he served in the American Urological Association’s Urologic Diagnostic and Therapeutic Imaging Task Force, from 2006-2010 he was on the Guidelines for the Management of small Renal Masses committee. Currently Dr Kaouk serves as Chairman elect on the AUA New Technology and Imaging committee, and is President Elect of (SURS) Society of Urologic Robotic Surgery. Dr Kaouk is associate editor of Urology journal.

Dr Kaouk have lectured in 130 scientific meetings, chaired 24 urologic meeting and performed live surgery in 18 medical centers worldwide. He authored 460 peer reviewed scientific publication, 26 book chapters and hundreds of scientific abstracts and surgical movies. Dr Kaouk received 32 honors and awards including Cleveland clinic innovator award twice, Teacher of the Year award, and EndoUrology 2017 Best Fellowship Program Director Award.

Presently, Dr Kaouk holds membership with the American Urological Association, the Endourological Society, Society of Urologic Oncology, Society of Robotic Surgery, and the Lebanese Order of Physicians. He is a fellow of the American college of Surgeons.