Trifecta Outcomes in Open, Laparoscopy or Robotic Partial Nephrectomy: Does the Surgical Approach Matter?

Ketan Mehra,Sri Harsha Bokka,Amit Jain,Lalgudi Narayanan Dorairajan,Sreenivasan Sreerag,Ramanitharan Manikandan

doi:10.15586/jkcvhl.2019.115

Abstract

This retrospective study evaluated perioperative outcomes of open partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN), and robot-assisted partial nephrectomy (RAPN) and identified predictive factors of Trifecta achievement for renal tumors that underwent partial nephrectomy (PN) in a single institutional cohort. The study involved patients who underwent PN from January 2011 to July 2018. Trifecta was defined as absence of perioperative complications, no positive surgical margins, and ischemia time <30 min. Fifty-five PN procedures were reviewed: 28 OPN, 14 LPN, and 13 RAPN. OPN, LPN and RAPN had similar median tumor size (5.75, 5.25, and 5 cm), nephrometry score (7, 6, and 6), and preoperative creatinine (1.09, 1.1, and 1.1 mg/dl, respectively). Blood loss was higher for OPN (550 ml) than for LPN (400 ml) and RAPN (300 ml), P = 0.042. Drain was removed after 6 days in OPN which was higher than LPN and RAPN (4.5 and 4 days, respectively), P = 0.008. OPN, LPN, and RAPN had similar median operative time (190, 180, and 180 min, respectively), P = 0.438. Median postoperative stay for OPN, LPN, and RAPN was 5, 6.5, and 10 days, respectively. Trifecta outcomes of 73.1%, 64.3%, and 61.53% were achieved in OPN, LPN, and RAPN, respectively, P = 0.730. It was concluded that Trifecta outcomes had no significant difference among OPN, LPN, and RAPN. LPN can produce as good results as RAPN. Keeping in mind the cost-effectiveness, LPN holds an important position in developing countries where expenditure by patient is a major factor.

Highlights

Partial nephrectomy (PN) is the preferred modality of treatment for small renal masses
The patient characteristics in Open partial nephrectomy (PN) (OPN), laparoscopic partial nephrectomy (LPN), and robot-assisted partial nephrectomy (RAPN) were similar in terms of median tumor size (5.75, 5.25, and 5 cm, respectively, P = 0.219), age (49 years, Range: 29–80; 48.5 years, Range:19–58; and 42 years, Range: 29–72, P = 0.338), median preoperative creatinine values (1.09, 1.1, and 1.1 mg/dl, respectively), and tumor complexities using RENAL nephrometry score as a measure (7, 6, and 7, respectively)
Median blood loss was higher for OPN (500 ml, Range: 100–2,000) than LPN (400 ml, Range: 150–750) and RAPN (300 ml, Range: 100–800), P = 0.042

Summary

Introduction

Partial nephrectomy (PN) is the preferred modality of treatment for small renal masses. The American Urological Association Guideline recommends nephron-sparing surgery for T1 renal mass, as there is increased risk of chronic kidney disease (CKD) associated with radical nephrectomy (RN) [1]. Does surgical approach for partial nephrectomy matter?. With advancements in laparoscopic techniques, equipment, and surgeons’ skills, laparoscopy has been adopted worldwide, thereby offering comparable oncological outcomes, less morbidity, and shortened convalescence compared to open approach [2,3,4,5,6,7]. With widespread diffusion of robotic technology, there is increased adoption of robotic-assisted partial nephrectomy in providing a minimally invasive option for patients with clinical T1a lesions

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