Hemorrhagic complications of robot-assisted laparoscopic partial nephrectomy for renal masses.

Abstract

621 Background: Partial nephrectomy is the current standard of care for T1a tumors. With advances in laparoscopy and robotic-assisted surgery, RPNx is increasingly being performed for complex renal tumors. However, significant hemorrhagic complications can occur. We review hemorrhagic complications following RPNx. Methods: At our institution 111 RPNx were performed on 110 patients (2011-2015). Demographic data and Nephrometry scores were determined. Total operating time, intraoperative blood loss, postoperative blood transfusion rate, gross hematuria, need for further procedures and mortality were collected. Pathology, including histologic diagnosis, and margin status was recorded. Results: Of 111 RPNx, 110 were done for renal masses and 112 masses were removed. Of these, 77% were malignant and most common commonly Renal Cell Carcinoma, Clear Cell pT1a (51%). Mean operative time was 245 minutes (SD 68), mean blood loss was 297 mL (SD 68), and average length of stay was 2.8 days. Hemorrhagic complications occurred in 21 patients (19%). Five had hematuria and 16 received a transfusion. Four patients required interventional radiology (IR) for angioembolization. Two patients died, one from hemorrhagic complications, and the other from septic shock related to a bowel injury. The most common Nephrometery score was 4a followed by 5a. Of those with hemorrhagic complications the most common Nephrometery score was 8, with 60% being 7 or higher. Among patients needing IR, 75% were 6 or higher and the one patient who died had a score of 11a in the setting of bilateral renal masses. Patients with hemorrhagic complications had a change in hemoglobin and hematocrit from per- to post-operation of 3.06 g/dL and 9.07% respectively compared to 2.34 g/dL and 6.28% for patients with no hemorrhagic complications. Conclusions: RPNx is a safe and nephron-sparing surgery for patients with appropriate renal masses. Significant hemorrhagic complications can occur, commonly managed with blood transfusions or angioembolization. However, catastrophic bleeding can occur in patients with high Nephrometry scores and monitoring in the ICU setting is recommended in high-risk patients.