Presentation Authors: Ahmet Bindayi*, San Diego, CA, Akbar Ashrafi, Los Angeles, CA, Koon Rha, Seoul, Korea, Republic of, Sisto Perdona, Naples, Italy, Giuseppe Simone, Rome, Italy, Chandru Sundaram, Indianapolis, IN, Andrea Minervini, Andrea Mari, Firenze, Italy, Benjamin Challacombe, Prokar Dasgupta, London, United Kingdom, Stephen Ryan, Madhumitha Reddy, San Diego, CA, Uzoma Anele, Richmond, VA, Giuseppe Quarto, Naples, Italy, Francesco Porpiglia, Orbassano, Italy, Michele Gallucci, Rome, Italy, Inderbir Gill, Los Angeles, CA, Riccardo Autorino, Richmond, VA, Monish Aron, Los Angeles, CA, Ithaar Derweesh, San Diego, CA
Introduction: Use of partial nephrectomy for clinical T3a renal mass (cT3aRM) is controversial. We sought to evaluate the quality outcomes of robot-assisted partial nephrectomy (RAPN).
Methods: Retrospective multicenter and multinational analysis of patients with nonmetastatic cT3a renal mass [RObotic SUrgery for LArge renal mass (ROSULA) Group]. Patient demographics, tumor characteristics, perioperative variables, renal functional data and pathological outcomes were analyzed. Primary endpoint was Trifecta, a composite quality outcome defined as negative surgical margin, warm ischemia time (WIT) â‰¤25 min, and no perioperative complications. â€œOptimal outcomeâ€ was define as achievement of Trifecta and â‰¥90% estimated glomerular filtration rate (eGFR) preservation and no chronic kidney disease (CKD) stage upgrading. Multivariable analysis (MVA) was used to identify risk factors associated lack of 'optimal outcome' achievement.
Results: A total of 100 patients with median age 60 [IQR: 56-69], median follow-up 16.8 [IQR 9-24.8] months were analyzed. Median tumor size and RENAL score were 7.7 [IQR: 6.6-8.2] cm and 9 [IQR: 9-10], respectively. In total, 24/100 (24%) patients underwent RAPN for imperative indications. Median operative time, blood loss and WIT were 200 [157-235] minutes, 300 [155-534] mL and 20 [15-21] minutes, respectively; 94 (94%) had negative margins. Intra- and postoperative complications were noted in 11 (11%) patients for each category, while 8 (8%) had major (Clavien-Dindo grade 3-5) complications. Median Î”eGFR was 8 ml/min/1.72m2, with â‰¥90% eGFR preservation noted in 52%. Trifecta rate was 64% and 41% achieved optimal outcome. MVA for factors associated with failure to achieve optimal outcome revealed increasing RENAL nephrometry score (OR 1.19, p=0.027), decreasing preoperative eGFR (OR 1.16, p=0.002), and increasing estimated blood loss (OR 1.05, p=0.038) as independent risk factors (Table).
Conclusions: RAPN for select cT3aRM is feasible and safe, with acceptable quality outcomes. Further investigation is requisite to delineate role in management of cT3a disease.