Surface-Intermediate-Base Research Articles

Impact of tumor dissecting technique on trifecta achievement in patients requiring extended warm ischemia during robot-assisted partial nephrectomy.

To clarify specific factors associated with surgical outcomes in robot-assisted partial nephrectomy (RAPN) that require extended warm ischemia time (WIT), which may have a negative impact, but cannot always be avoided. We included 1,182 patients who had RAPN performed between January 2016 and December 2022 from a prospectively generated multi-institutional RAPN database, divided into normal WIT (nWIT) (≤ 20min; 843 patients) and extended WIT (eWIT) (> 20min; 339 patients) groups. Primary outcome measures were WIT and the Surface-Intermediate-Base (SIB) margin score, which contribute to postoperative trifecta achievement. Results were compared between the two groups using logistic regression. Patients in the eWIT group had larger tumors, higher RENAL nephrometry scores, and lower SIB scores than those of the nWIT group. The trifecta achievement rate was significantly different between the two groups (nWIT: 70.1 vs. 49.0%, p < 0.001). In the nWIT group, WIT (coefficient: -0.105 [standard error 0.020], p < 0.001) and SIB score (coefficient: -0.107 [0.053], p = 0.045) were significant predictors of trifecta achievement. In the eWIT group, the SIB score (coefficient - 0.216 [0.082], p = 0.008) was significantly associated with trifecta attainment, whereas WIT only showed a trend toward significance. Limitations included a lack of long-term survival, renal function, and chronic complications data. For patients with eWIT during RAPN, the tumor dissection technique may be more important than WIT in predicting postoperative outcomes. Further prospective studies are required to confirm our results.

Predictors of Positive Surgical Margins after Robot-Assisted Partial Nephrectomy for Localized Renal Tumors: Insights from a Large Multicenter International Prospective Observational Project (The Surface-Intermediate-Base Margin Score Consortium).

Background: To explore predictors of positive surgical margins (PSM) after robotic partial nephrectomy (PN) in a large multicenter international observational project, harnessing the Surface-Intermediate-Base (SIB) margin score to report the resection technique after PN in a standardized way. Methods: Data from consecutive patients with cT1-2N0M0 renal masses treated with PN from September 2014 to March 2015 at 16 tertiary referral centers and included in the SIB margin score International Consortium were prospectively collected. For the present study, only patients treated with robotic PN were included. Uni- and multivariable analysis were fitted to explore clinical and surgical predictors of PSMs after PN. Results: Overall, 289 patients were enrolled. Median (IQR) preoperative tumor size was 3.0 (2.3–4.2) cm and median (IQR) PADUA score was 8 (7–9). SIB scores of 0–2 (enucleation), 3–4 (enucleoresection) and 5 (resection) were reported in 53.3%, 27.3% and 19.4% of cases, respectively. A PSM was recorded in 18 (6.2%) patients. PSM rate was 4.5%, 11.4% and 3.6% in case of enucleation, enucleoresection and resection, respectively. Patients with PSMs had tumors with a higher rate of contact with the urinary collecting system (55.6% vs. 27.3%; p < 0.001) and a longer median warm ischemia time (22 vs. 16 min; p = 0.02) compared with patients with negative surgical margins, while no differences emerged between the two groups in terms of other tumor features (i.e., pathological diameter, PADUA score). In multivariable analysis, only enucleoresection (SIB score 3–4) versus enucleation (SIB score 0–2) was found to be an independent predictor of PSM at final pathology (HR: 2.68; 95% CI: 1.25–7.63; p = 0.04), while resection (SIB score 5) was not. Conclusions: In our experience, enucleoresection led to a higher risk of PSMs as compared to enucleation. Further studies are needed to assess the differential impacts of resection technique and surgeon’s experience on margin status after robotic PN.

Intraoperative ultrasound: technique and clinical experience in robotic-assisted renal partial nephrectomy for endophytic renal tumors.

Surgical removal of completely endophytic renal tumors has presented great technical difficulties for surgeons. In this study, we aim to introduce the role and use of intraoperative ultrasound (IOUS) performed in robotic-assisted renal partial nephrectomy (RAPN) for endophytic renal tumors. We retrospectively assessed the demographics data and surgical outcomes of 58 consecutive endophytic renal tumor patients who were all attributed 3 points for the 'E' domain of the RENAL nephrometry score or 3 points for the exophytic rate of the PADUA score between October 2016 and September 2018. 38 patients who had undergone RAPN with IOUS were grouped. RAPN was carried out in another 20 patients without IOUS and these 20 patients were also grouped. Patients in IOUS-guided group had significantly lower estimated blood loss (P < 0.001), shorter warm ischemia time (P = 0.010) and improved MIC (Margin, ischemia, and complications) rate (P = 0.026) and Pentafecta achievement (P = 0.016) compared to non IOUS-guided group. In multivariate logistic regression analysis, RAPN with IOUS was an independent predictor of MIC achievement (odds ratio 3.595; confidence interval 1.023-12.633; P = 0.046). Surface-intermediate-base (SIB) margin score was lower for IOUS-guided group vs non IOUS-guided group (P = 0.029). RAPN for completely endophytic renal tumors is a feasible procedure in terms of complication rates, oncologic and functional outcomes. A robotic ultrasound probe operated by console surgeon generates a favorable perioperative outcomes and surgical margin rates after RAPN.

Assessing the Association of Surface-Intermediate-Base Margin Score with Perioperative Outcomes and Parenchymal Volume Preserved during Partial Nephrectomy

Introduction: The present study aimed to compare the assessment of volume preservation and perioperative outcomes during partial nephrectomy (PN), according to the surface-intermediate-base (SIB) score. Methods: This prospective study included 80 patients diagnosed with renal cell carcinoma who underwent PN for a renal mass from 2014 to 2017. SIB score was macroscopically evaluated immediately after the surgery. Preoperative assessment of volume preservation (PAVP), surgeon assessment of volume preservation (SAVP), duration of ischemia, perioperative complications, pathological data, and the values of preoperative and postoperative estimated glomerular filtration rate (eGFR) were recorded. Results: A strong correlation was determined between PAVP and SAVP (R = 0.82, R² = 0.68, p < 0.0001) and between vGFR-PAVP and vGFR-SAVP calculated using the adapted eGFR (preop eGFR × [PAVP or SAVP]) (R = 0.97, R² = 0.95, p < 0.001). In multivariate analysis, preoperative tumor size, SIB score (1–2 vs. 3–5), and vGFR (PAVP and SAVP model) were significant predictors of postoperative eGFR. A low base score was associated with surgical margin positivity, and a high SIB score (≥3) was associated with perioperative complications (p = 0.017; p = 0.028). Conclusion: The SIB score can be considered a reliable surrogate for volume preservation after PN because it is strongly associated with both PAVP and SAVP. SIB score is useful in predicting functional outcomes, complications, and surgical margin positivity.

Predictors of early postoperative and mid-term functional outcomes in patients treated with Endoscopic Robot-Assisted Simple Enucleation (ERASE): results from a tertiary referral center.

The aim of this study was to assess the early and mid-term functional outcomes of Endoscopic Robot Assisted Simple Enucleation (ERASE) verified through a standardized tumor-resection reporting system (Surface Intermediate Base [SIB] score) and to investigate for predictors of renal function (RF) loss in patients with T1 renal tumors treated in a tertiary referral institution. Data of 553 patients treated with ERASE were analyzed. Only patients with SIB score of 0-1 and negative oncological follow-up were included. A ≥25% drop from baseline of estimated glomerular filtration rate (eGFR) was considered as a clinically meaningful functional loss. Multivariable regression models tested the relation between clinical features and RF loss at postoperative day (POD) 3 and at last follow-up. Overall, 347 patients with SIB 0-1 entered the study. A RF drop ≥25% was observed in 178 (37%) patients in POD 3 and in 91 (18.9%) patients at a median follow-up of 36 months, respectively. At multivariable analysis, age at surgery and PADUA score were significant predictive factors of clinically significant RF loss at POD 3, while age at surgery, female gender, higher BMI, Charlson Comorbidity Index (CCI) and preoperative eGFR were significant predictors of RF loss at last follow-up. Age at surgery and higher PADUA score are significant predictors of early postoperative RF loss after ERASE for T1 renal tumors, while age at surgery, female gender, higher BMI, CCI and baseline RF significantly affect mid-term RF. Larger studies and a longer follow-up are needed to confirm these results.

Oncologic outcomes in patients treated with endoscopic robot assisted simple enucleation (ERASE) for renal cell carcinoma: Results from a tertiary referral center

IntroductionOpen Simple Enucleation (OSE) has been demonstrated to be an oncologically safe alternative to standard partial nephrectomy. We assessed the mid-term oncologic outcomes and predictors of disease recurrence in patients treated with Endoscopic Robot-Assisted Simple Enucleation (ERASE) verified through a standardized reporting system at a single institution. Material and methodsThe clinical data of patients treated with ERASE for renal cell carcinoma at our Institution from January 2012 to September 2018 were retrospectively reviewed. Surface-Intermediate-Base (SIB) score was evaluated immediately after surgery. Patients with a ≥2 SIB score were excluded. The local and distant recurrence rates, the recurrence-free (RFS), cancer-specific (CSS) and overall (OS) survival were assessed. Kaplan-Meier and log-rank test were used to estimate survivals and to compare recurrence-free survival. ResultsOverall, 259 patients were considered eligible for the present study. The median PADUA score was 7 (interquartile range [IQR] 6–9). Positive surgical margins (PSM) were registered in 7 (2.7%) cases. Median (IQR) follow-up time was 36 (27–51) months. Overall, 4 (1.5%) patients experienced systemic recurrence (SR) and 5 (1.9%) patients experienced local recurrence alone (LR) of whom 3 (1.1%) were on tumor resection bed, and 2 (0.8%) experienced recurrence elsewhere in the ipsilateral kidney. The 5-year RFS, CSS and OS were 94.2%, 98.9% and 93.6%, respectively. Higher nucleolar grade and PSM were the two factors significantly associated with worse RFS. ConclusionsERASE is a safe procedure, achieving negative surgical margins in the vast majority of patients and providing excellent mid-term local control and oncologic outcomes.

P141 - Surgical and perioperative outcomes after robotic tumor enucleation vs non-enucleative techniques for localized renal masses: Results of a multicenter prospective study from the surface-intermediate-base (SIB) margin score international consortium

P141 - Surgical and perioperative outcomes after robotic tumor enucleation vs non-enucleative techniques for localized renal masses: Results of a multicenter prospective study from the surface-intermediate-base (SIB) margin score international consortium

V40 - Toward standardized reporting of resection strategies and resection techniques for partial nephrectomy: Insights from a multicenter prospective study within the Surface-Intermediate-Base (SIB) margin score international consortium

V40 - Toward standardized reporting of resection strategies and resection techniques for partial nephrectomy: Insights from a multicenter prospective study within the Surface-Intermediate-Base (SIB) margin score international consortium

P266 - Patterns and predictors of resection techniques during partial nephrectomy: Results of a multicenter prospective study from the Surface-Intermediate-Base (SIB) margin score international consortium (IDEAL Phase 2B)

P266 - Patterns and predictors of resection techniques during partial nephrectomy: Results of a multicenter prospective study from the Surface-Intermediate-Base (SIB) margin score international consortium (IDEAL Phase 2B)

1044 - Patterns and predictors of resection techniques during partial nephrectomy for T1 renal masses: Results of a multicentre prospective cohort study from the surface-intermediate-base (SIB) margin score international consortium (IDEAL phase 2b)

1044 - Patterns and predictors of resection techniques during partial nephrectomy for T1 renal masses: Results of a multicentre prospective cohort study from the surface-intermediate-base (SIB) margin score international consortium (IDEAL phase 2b)

Outcomes of robot-assisted simple enucleation of renal masses: A single European center experience.

The aim of this study was to assess the ability of pre-and intraoperative parameters, to predict the risk of perioperative complications after robot-assisted laparoscopic simple enucleation (RASE) of renal masses, and to evaluate the rate of trifecta achievement of this approach stratifying the cohort according to the use of ischemia during the enucleation.From April 2009 to June 2016, 129 patients underwent RASE at our Institution. We stratified the procedures in 2 groups: clamping and clamp-less RASE. After RASE, all specimens were retrospectively reviewed to assess the surface–intermediate–base (SIB) scoring system. Patients were followed-up according to the European Association of Urology guidelines recommendations. All pre-, intra-, and postoperative outcomes were prospectively collected in a customized database and retrospectively analyzed.A total of 112 (86.8%) patients underwent a pure RASE and 17 (13.2%) had a hybrid according to SIB classification system. The mean age was 61.17 years. In 21 patients (16.3%), complications occurred, 13 (61.9%) were Clavien 1 and 2, while 8 were Clavien 3a and b complications. Statistical significant association with complications was found in patients with American Society of Anestesiology (ASA) score 3 (44.5%, P = .04), longer mean operative time (OT) 195 versus 161.36 minutes (P =.03), mean postoperative hemoglobin (Hb) 10.1 versus 11.8 (P <.001), and mean ΔHb 3.59 versus 2.18 (P <.001). In multivariate logistic regression, only longer OT and ΔHb were statistical significant predictive factors for complications. In sub-group analysis, clamp-less RASE was safe in terms of complications (14.1%), positive surgical margins (1.3%), and mid-term local recurrence (1.3%). Although in this approach there is higher EBL (P = .01), this had no impact on ΔHb (P = .28). A clamp-less approach was associated with a higher rate of SIB 0 (71.8% vs 51%, P = .02), higher trifecta achievement (84.6% vs 62.7%, P = .004), and better impact on serum creatinine (mean 0.83 vs 0.91, P = .01).RASE of renal tumors is a safe technique with very good postoperative outcomes. Complication rate is low and associated with ASA score >3, longer OT, and ΔHb. RASE is suitable for the clamp-less approach, which allows to perform easier the pure enucleation (SIB 0) and to obtain higher rates of trifecta outcomes.

PD29-09 PARTIAL NEPHRECTOMY IN A COHORT OF “ENUCLEORESECTIVE” CENTERS: INSIGHTS FROM THE SURFACE–INTERMEDIATE–BASE (SIB) MARGIN SCORE INTERNATIONAL CONSORTIUM

PD29-09 PARTIAL NEPHRECTOMY IN A COHORT OF “ENUCLEORESECTIVE” CENTERS: INSIGHTS FROM THE SURFACE–INTERMEDIATE–BASE (SIB) MARGIN SCORE INTERNATIONAL CONSORTIUM

865 Predictive factors of resection techniques during partial nephrectomy in a cohort of “enucleative” centres: Insights from the Surface–Intermediate–Base (SIB) Margin score International Consortium

865 Predictive factors of resection techniques during partial nephrectomy in a cohort of “enucleative” centres: Insights from the Surface–Intermediate–Base (SIB) Margin score International Consortium

864 Beyond the complexity of tumour excision during partial nephrectomy: Ideation and histopathological validation of the Surface-Intermediate-Base (SIB) margin score

864 Beyond the complexity of tumour excision during partial nephrectomy: Ideation and histopathological validation of the Surface-Intermediate-Base (SIB) margin score

V46 Prospective evaluation of the Surface-Intermediate-Base (SIB) margin score for standardized reporting of resection technique during robot-assisted partial nephrectomy (RAPN) in a high-volume center: A step-by-step tutorial

V46 Prospective evaluation of the Surface-Intermediate-Base (SIB) margin score for standardized reporting of resection technique during robot-assisted partial nephrectomy (RAPN) in a high-volume center: A step-by-step tutorial

304 Histopathological validation of the Surface-Intermediate-Base (SIB) margin score for standardized reporting of resection techniques during nephron-sparing surgery (NSS)

304 Histopathological validation of the Surface-Intermediate-Base (SIB) margin score for standardized reporting of resection techniques during nephron-sparing surgery (NSS)