Introduction

It is recommended to remove suspect cystic renal tumours when they are classified as Bosniak ≥3. These masses are fragile and may rupture during dissection or tumour excision. The impact of this intraoperative spillage on oncological outcomes remains uncertain. The objective of this study was to assess incidence of intraoperative cystic rupture according to surgical approach and its impact on oncological outcomes._x000D_

Methods

Between 2005 and 2015, patients who had a partial nephrectomy (PN) in height European centres have been retrospectively analysed. We specifically sought if there was a cystic spillage during the procedure. Oncological outcomes included overall survival (OS), disease specific survival (DSS) and recurrence-free survival (RFS). We performed a sub-group analysis on surgical approach (open partial nephrectomy (OPN) vs. robot-assisted partial nephrectomy (RAPN)) and on the existence of intraoperative cystic spillage (ICS) to determine their impact on oncological outcomes. Kaplan-Meier curves of RFS were produced. A multivariate analysis with logistic regression model was used to assess predictors of intraoperative cystic spillage._x000D_

Results

Overall, 268 patients were included. Malignancy of cystic renal masses was found in 75% of cases. Among them, 84.5% were Bosniak IV, 68% were Bosniak III and 62.5% were Bosniak IIF on preoperative CT-scan. With a mean follow-up of 32 months, OS was 95.1%, only 2% had a local recurrence, metastatic progression was found in 2% of cases and there was no specific-disease death. We reported intraoperative cystic spillage (ICS) in 18.7% (n=50) of cases (20% during RAPN vs. 18% during OPN). Among them, 77.5% were confirmed to be malignant after pathological analysis. In the ICS subgroup, with a median follow-up of 38 months, no local recurrence or metastatic progression was reported. Analyses of RFS did not found any difference among subgroups: ICS vs. no ICS (P=0.23) (Figure 1), OPN vs. RAPN (P=0.91) (Figure 2). No predictive factor of ICS was found.

Conclusions

Intraoperative cystic spillage is rather common regardless the surgical approach, and it does not seem to impact mid-term oncological outcomes.

Funding

none