1262 ROBOT-ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR HEREDITARY OR MULTIFOCAL KIDNEY CANCER: FEASIBILITY AND PERIOPERATIVE OUTCOMES

Abstract

You have accessJournal of UrologyKidney Cancer: Localized1 Apr 20111262 ROBOT-ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR HEREDITARY OR MULTIFOCAL KIDNEY CANCER: FEASIBILITY AND PERIOPERATIVE OUTCOMES Kevin Asher, Gopal Gupta, Compton Benjamin, Peter Pinto, W. Marston Linehan, and Gennady Bratslavsky Kevin AsherKevin Asher Bethesda, MD More articles by this author , Gopal GuptaGopal Gupta Bethesda, MD More articles by this author , Compton BenjaminCompton Benjamin Bethesda, MD More articles by this author , Peter PintoPeter Pinto Bethesda, MD More articles by this author , W. Marston LinehanW. Marston Linehan Bethesda, MD More articles by this author , and Gennady BratslavskyGennady Bratslavsky Bethesda, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.947AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Partial nephrectomy has emerged as the preferred treatment strategy for hereditary or multifocal renal cell carcinoma (RCC). We describe perioperative, functional, and oncologic outcomes of patients with hereditary or multifocal RCC using robot-assisted laparoscopic partial nephrectomy (RALPN). METHODS We queried our prospectively maintained urologic oncology database to identify all hereditary RCC patients or those with multifocal RCC who underwent RALPN. Demographic and perioperative data were reviewed. Preoperative radiographic characteristics, pathology, renal functional (preoperative and at 3 months postop) as well as oncologic outcomes were recorded. Comparisons of preoperative and postoperative renal function were performed using the student T-test. RESULTS Fifty-five RALPN (including 8 staged bilateral) were performed in 47 patients that included 23 (49%) VHL, 12 (25%) BHD, 5 (11%) BMF papillary RCC, and 7 others with various familial RCC syndromes. Six cases (11%) required conversion to open procedure, two of which were performed in patients with previous ipsilateral renal intervention. Two intraoperative complications occurred (4.1%) including a pneumothorax and a renal vein injury necessitating conversion to open surgery and nephrectomy. Operative and pathologic outcomes are listed in the Table.. There was no difference in mean preoperative and postoperative estimated GFR which was 87.8 ml/min/1.73m2 (30.8–186.9) and 83.5 (29.9–176.0), respectively (p=0.25), while mean ipsilateral renal scan function was significantly lower postoperatively (52.4% (42–70) preop vs 48.4% (29–73) postop, p<0.01). At a median follow up of 12.9 months (range 0.1–36.2) overall survival was 98% with one patient dying from metastatic disease that was present prior to surgery. No other patient has required reintervention or developed metastasis. Operative Outcomes and Tumor Histology Number of Procedures 55 Number Completed Robotically, (%) 49(89) Mean age, yrs (range) 45.9(19–76) No. of Cases Performed on Kidney with prior ipsilateral intervention, (%) 11(20) Median Largest Radiographic Tumor Size, cm (range) 3.2(1.3–8) Median Nephrometry Score, (range) 8(4–11) Mean Operative time, min (range) 330(152–535) Mean Estimated Blood Loss, mL (range) 580(100–1600) Cases performed without renal ischemia (%) 16(33) Median warm ischemia time in cases with hilar clamping, min, (range) 27 (14–61) Reasons for the 6 conversions Bleeding (n=3), positive surgical margin (n=1), additional tumor identified (n=1), failure to progress (n=1) Histology of Resected Lesions, no, (%) Clear Cell 40(73) Hybrid Oncocytic 8(15) Papillary 5(9) Chromophobe 1(2) Lymphangiomyoma 1(2) CONCLUSIONS RALPN is feasible and safe for select patients with hereditary renal cancer syndromes or those who present with multifocal RCC. A significant proportion of RPNs in hereditary RCC may be completed without hilar occlusion allowing for excellent renal functional outcomes. Oncologic outcomes are encouraging but will require longer follow up. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e504 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Asher Bethesda, MD More articles by this author Gopal Gupta Bethesda, MD More articles by this author Compton Benjamin Bethesda, MD More articles by this author Peter Pinto Bethesda, MD More articles by this author W. Marston Linehan Bethesda, MD More articles by this author Gennady Bratslavsky Bethesda, MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...