Category: Laparoscopic/ Robotic: Other
Introduction & Objective : With improved advanced imaging and careful patient selection, we hypothesized that we are more accurately predicting the malignant kidney tumors that require removal, obviating the need for routine pre-operative biopsy.
Methods : Between January 2012 and January 2018 we identified 174 patients who underwent robotic partial nephrectomy for pre-operative imaging that suggested malignancy. None of those patients underwent pre-operative biopsy of the suspicious tumor. We analyzed pre-operative, intra-operative, and post-operative characteristics of those patients.
Results : Median age was 57.5 (IQR: 49-65). 60% of the cohort were men (Women 40%). Median BMI was 30.8 (IQR: 27.4-35). Median Nephrometry Score was 8 (IQR: 7-9) and median pre-operative size was 3.1 cm (IQR: 2.2-4.3). All patients underwent successful robotic partial nephrectomy with no conversion to open approach or total nephrectomy. Total surgery time was 200 minutes (IQR: 160-240); console time was 150 minutes (IQR: 110-185). Clamping time was 25 minutes (IQR: 20-31). Median estimated blood loss was 100 ml (IQR: 50-100). 27 patients (16%) of patients had peri-operative complications, with 4% presenting with delayed bleeding requiring embolization. Pathology showed benign tumors in only 5% of patients. The benign pathologies were: Oncoytoma 3%, AML 1%, and Cyst 1%. Malignant pathologies were: Clear cell 66%, Papillary 25%, and Chromophobe 4%. 9% of patients had positive margins on final pathology. No patients had local recurrence.
Conclusions : Unlike historical data that suggest 15-20% benign histology in partial nephrectomy specimens, our data had a much lower percentage of benign pathology. This finding poses another question about the necessity of routine pre-operative biopsy of kidney tumors.
Rabii Madi– Professor of Urology, Medical College of Georgia at Augusta University Health, Augusta, Georgia
Jiemin Li– Augusta, Georgia
Miller Singleton– Augusta, Georgia
Alan Carnes– Resident, Augusta University, Augusta, Georgia
Benjamin Harper– Resident, Augusta University, Augusta, Georgia
Professor of Urology
Medical College of Georgia at Augusta University Health