You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy V1 Apr 2017MP72-17 ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR COMPLEX CASES (PADUA SCORE = 10): RESULTS FROM A MULTICENTER EXPERIENCE AT THREE HIGH-VOLUME CENTERS Giovanni Lughezzani, Nicolo' Buffi, Giuliana Lista, Davide Maffei, Giovanni Forni, Nicola Fossati, Alessandro Larcher, Massimo Lazzeri, Alberto Saita, Paolo Casale, Giorgio Guazzoni, Jim Porter, and Alex Mottrie Giovanni LughezzaniGiovanni Lughezzani More articles by this author , Nicolo' BuffiNicolo' Buffi More articles by this author , Giuliana ListaGiuliana Lista More articles by this author , Davide MaffeiDavide Maffei More articles by this author , Giovanni ForniGiovanni Forni More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , Massimo LazzeriMassimo Lazzeri More articles by this author , Alberto SaitaAlberto Saita More articles by this author , Paolo CasalePaolo Casale More articles by this author , Giorgio GuazzoniGiorgio Guazzoni More articles by this author , Jim PorterJim Porter More articles by this author , and Alex MottrieAlex Mottrie More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2253AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We assessed the feasibility of robot-assisted partial nephrectomy (RAPN) in a contemporary series of patients with highly-complex tumors (PADUA score≥ 10) treated at three high-volume robotic surgery institutions. METHODS Data from a multi-institutional database on patients subjected to RAPN for clinically-localized kidney cancer between 2010 and 2016 were reviewed. Overall, 198 patients with highly-complex renal tumors, defined as a PADUA score≥ 10, were included. Complications, functional and oncological outcomes were assessed. Optimal surgical outcomes, defined according to the Margin Ischemia and Complications (MIC) binary system (absence of Clavien-Dindo >2 complications, warm ischemia time [WIT] <20 minutes and absence of positive surgical margins) were assessed. Finally, predictors of optimal surgical outcomes were determined using logistic regression models (LRMs). RESULTS Median patient age was 61.5 years (IQR: 53-68), median preoperative tumor size was 43 mm (IQR 28-54), and median preoperative creatinine was 0.92 mg/dL (IQR: 0.80-1.13). Overall, 91 (46.0%) patients had a PADUA score 10, followed by 65 (32.8%) with a score of 11, 33 (16.7%) with a score of 12 and 9 (4.5%) with a score of 13. Median operative time was 180 minutes (IQR: 131-221), median WIT was 18 minutes (IQR: 15-22), and median estimated blood loss was 150 ml (IQR: 100-300). WIT was > 20 minutes in 62 (31.3%) patients, while a Clavien-Dindo >2 complication and positive surgical margins were observed in 12 patients (5.0%) and 4 (2.0%) individuals, respectively. Optimal surgical outcomes were achieved in 126 (63.6%) patients. Median creatinine the day after surgery was 1.10 mg/dL and remained stable 2 weeks later (median: 1.10 mg/dL. At a median follow-up of 22 months, no local or distant recurrence of the disease was observed. In multivariable LRMs, after adjustment for patient age, gender, BMI, side, CCI, and tumor size, extremely complex tumors (PADUA score 12-13) were associated with a 2.7 -fold higher risk of not achieving optimal outcomes (OR: 1.03-7.02; p=0.044). In addition, males showed a 2.31-fold higher risk of not achieving optimal surgical outcomes (95%CI: 1.04-5.14; p=0.040) relative to their female counterparts. CONCLUSIONS In experienced hands, RAPN can be considered as an effective treatment option even for complex renal lesions. Increasing tumor complexity may affect the surgical outcomes even in this highly-selected patient population. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e961 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Giovanni Lughezzani More articles by this author Nicolo' Buffi More articles by this author Giuliana Lista More articles by this author Davide Maffei More articles by this author Giovanni Forni More articles by this author Nicola Fossati More articles by this author Alessandro Larcher More articles by this author Massimo Lazzeri More articles by this author Alberto Saita More articles by this author Paolo Casale More articles by this author Giorgio Guazzoni More articles by this author Jim Porter More articles by this author Alex Mottrie More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...