The application of renal sinus anatomy based tension-free reconstruction technique for robot-assisted nephron-sparing surgery of hilar tumors: a single center report and follow-up of 286 cases

Abstract

Objective To describe our renal sinus anatomy based tension-free reconstruction step by step and report perioperative data and long-term outcomes of patients undergoing robot-assisted nephron-sparing surgery for hilar tumors. Methods From June 2013 to December 2016, data of 286 consecutive patients with hilar tumor who underwent RAPN in single center were retrospectively reviewed.There were 202 males and 84 females, aged(56.2±9.2)years.The body mass index was(26.8±3.5)kg/m2.The median diameter of tumor was 2.6 cm(0.8-6.0 cm), and R. E.N.A.L.score was 8.2±1.8. The anatomy-based Garland specialized in protecting the large hilar vessels and minimizing the tension of trans/retroperitoneal defect suturing approach for anterior/posterior lip hilar tumor respectively. Patient′s perioperative complications and long-term follow-up including renal function and oncological outcomes were analyzed. Results Garland technique was successfully applied in 284 patients, the warm ischemia time (WIT) was (18.2±4.1) min. Median estimated blood loss (EBL) for RAPN was 100 ml (range: 10-600 ml). Median operative time was 120 min (range: 60-230 min). No patient was converted to open surgery. Postoperative hospital stay was 4.0 d (range: 2.0-9.0 d). Three patients (1.1%) had positive surgical margins. Of all the pathological results, 260 cases (91.5%)were clear renal cell carcinoma, 8 cases (2.8%)were chromophobe renal carcinoma, 7 cases (2.5%)were papillary type renal cell carcinoma, 5 cases(1.8%) were oncocytoma, 3 cases (1.1%)were angiomyolipoma, one case (0.3%)was mucinous tubular and spindle cell carcinoma. Two patients underwent blood transfusion. Three patients(1.0%) had local recurrence.284 patients were alive at a median follow-up of 36 months (range: 12-54 months). Conclusions Garland technique is safe and feasible for hilar tumor resection and reconstruction with less surgical complications. Large renal vessel injury was avoided and tension of wound closure was minimized. The trans/retroperitoneal approaches are capable for anterior/posterior hilar tumor. Patients with hilar tumor could benefit from robotic surgery with a well preserved renal function and good oncological outcomes. Key words: Kidney neoplasms, renal hilum; Robot; Nephron-sparing surgery; Renal sinus anatomy; Kidney reconstruction