Robot-assisted repeat resection of recurrent kidney tumors

Abstract

Background. Currently, organ-preserving surgery of kidney tumors often involves robot-assisted access. It can also be used in partial nephrectomy in patients with local recurrence after previous resection.Aim. To evaluate the effectiveness of repeat robot-assisted partial nephrectomy of recurrent kidney tumors.Materials and methods. At the Urology Center of the Mariinsky Hospital (Saint Petersburg) between 2018 and 2022 robot-assisted partial nephrectomy was performed in 86 patients (46 (59.5 %) men and 40 (40.5 %) women) with stage Т1а (n = 72) and Tib (n = 14) kidney tumors. Mean patient age was 58.0 ± 8.5 years, tumor size varied between 1.2 and 5.2 cm. Seven (7) patients were operated on due to tumor recurrence after previously performed partial nephrectomy. In all cases, lesion was located outside the site of primary resection. Mean time between the 1st and 2nd surgeries was 24 (12-46) months. Histological examination of primary tumor showed renal cell carcinoma in 4 patients, papillary carcinoma in 2 patients, chromophobe carcinoma in 1 patient. In 5 patients, one recurrent lesion was diagnosed, in 2 patients - two. Ligation of the renal artery was performed in 2 patients, its branch - in 3, ischemia-free resection - in 2 patients. Evaluation of mean operating time, blood loss volume, warm ischemia time, pre- and postoperative kidney function was performed.Results. Mean operating time of repeat partial nephrectomy was 180 (130-210) minutes. Warm ischemia time for renal artery ligation was 16 and 20 minutes, for selective ischemia 14, 18 and 24 minutes. Mean blood loss volume was 220 (80-650) ml. No intraoperative complications were observed, grade I-II postoperative complications per the Clavien classification were observed in 2 patients. Mean decrease in glomerular filtration time was 8 % (from 62 to 54 mL/min/1.73 m2). During 16-month follow up period, tumor recurrence was not observed.Conclusion. Robotic access allows to safely and effectively perform resection of recurrent kidney tumors with satisfactory functional and intermediate oncological outcomes.