Presentation Authors: Manar Malki*, Muddassar Hussain, Neil Barber, Frimley, United Kingdom
Introduction: Partial nephrectomy is the gold standard treatment for small renal masses. Currently, robot-assisted partial nephrectomy (RAPN) is the most common approach. Traditionally, RAPN is performed via the transperitoneal approach in most renal cancer centres. A few institutions have reported on outcomes and safety of retroperitoneal robot-assisted partial nephrectomy. Most of these studies had small number of patients. In this study, we report on surgical outcomes of R-RAPN.
Methods: From April 2012 to September 2018, 442 patients underwent RAPN, of whom 397 patients had R-RAPN. We reviewed patients&[prime] demographic, operative data, peri-operative and postoperative complications, postoperative histology.
Results: Two thirds of patients (66.2%) were men. The median age was 60 years (interquartile range [IQR] 52 - 69). The mean body mass index (BMI) is 28.5 kg/m2 (IQR 25.1 - 31.0). Median maximum tumour diameter was 3.0 cm (IQR 2.0 - 3.7). The median R.E.N.A.L nephrometry score is 6 (IQR 5 - 8). Almost half (46.6%) of excised tumours were located posteriorly. Median operative time and warm ischaemia time were 129 min (IQR 105.6 - 150) and 21 min (IQR 17.2 - 26.2) respectively. Median estimated blood loss is 20 mL. The median length of stay (LOS) is 1 day ( IQR 1 - 2).Two cases were converted to open partial nephrectomy and 6 cases were converted to robotic assisted radical nephrectomy (total 2%). 18 patients (4.5%) experienced post-operative complications ( â‰¥ grade 2 Clavien-Dindo classification system). The rate of peri-operative transfusion was 1%. 55% of tumours were reported as clear cell carcinomas (table 1). 80% of tumours were histologically staged as T1a with six positive margins (1.8%). There are only 3 reported recurrences (0.7%) with median follow-up of 35 months. The rate of achieving Trifecta (negative surgical margin, no postoperative complications and warm ischaemia time of â‰¤ 25 minutes) was 67.3%
Conclusions: Retroperitoneal RAPN represents a valid approach to treat patients with posterior and most anterior small renal masses. R-RAPN is safe, achieves the required trifecta and a very short LOS. To best to our knowledge, our study represents the world&[prime]s largest single institution reported study on retroperitoneal RAPN.