Category: Laparoscopic/ Robotic: Other
Introduction & Objective :
Nephron Sparing Surgeries (NSS) are preferred alternatives to radical nephrectomy for the management of renal tumors less than 4 cm in size. However, compared to radical nephrectomy, NSS carry a higher rate of recurrence, estimated at 4-10%. To date, the common management of local failure after nephron sparing surgery (NSS) is radical nephrectomy. There is limited data regarding redo-laparoscopic ipsilateral renal surgery in the salvage setting. The objective of this study is to review our institutional experience and to assess the feasibility and efficacy of salvage robotic partial nephrectomy in appropriately selected patients.
Methods : Chart-review was conducted on all patients who underwent robotic partial nephrectomy (n = 200) performed by a single surgeon (RM) from August 2012 to August 2017. All patients that underwent salvage robotic partial nephrectomy were identified. Patient demographic, surgical, and follow-up data was collected. Descriptive statistics were used to analyze the selected cases
Eight patients, five males and three females, underwent salvage robotic partial nephrectomy. Primary therapies included hand-assisted laparoscopic partial nephrectomy (n=1), cryotherapy (n=4), radiofrequency ablation (n=1), and robotic partial nephrectomy (n=2). Seven of the patients were had failure of primary therapy, while one experienced de novo recurrence. Mean age was 56.9 ± 16.4, and mean BMI was 31.7 ± 7.5. Mean initial tumor size was 2.76 cm ± 0.93, with mean salvage tumor size of 2.67 cm ± 1.85. Mean preoperative and postoperative hematocrit was 44.9 ± 4.80 and 38.9 ± 4.57, respectively. Mean preoperative and postoperative creatinine was not significantly different, 1.04 ± 0.34 versus 1.3 ± 0.48. Mean warm ischemia time was 21.75 ± 15.3 minutes. There was no vascular clamping in two of the cases. WIT exceeded 30 minutes in only one case, at 43 minutes. Mean console time was 177.63 ± 58.39 minutes. Pathology confirmed malignancy in seven of the eight patients. None of the patients had recurrence at last follow-up.
Conclusions : In this preliminary experience, salvage robotic partial nephrectomy was a feasible and safe alternative to radical nephrectomy for the management of suspected recurrent renal cell carcinoma initially managed by NSS. Salvage robotic partial nephrectomy is technically difficult and should be reserved for properly selected patients who might benefit from nephron sparing.
Professor of Urology
Medical College of Georgia at Augusta University Health