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Sources of Funding: none

Introduction

Simple enucleation has been proved oncologically safe. The aim of the present study is to compare perioperative results and early oncological outcomes of modified robot-assisted simple enucleation (MRASE) with laparoscopic simple enucleation (MLSE) for treating localized renal tumors in our large institutional experience.

Methods

We evaluated 581 consecutive patients who underwent MRASE or MLSE for renal tumors in our institution from November 2012 to October 2016 in terms of perioperative and oncologic outcome variables. Propensity score matching was performed on age, gender, ECOG score, tumor size, preoperative estimated glomerular filtration rate and PADUA score. Modified simple enucleation was performed with robotic or laparoscopic system. The surgeon used the pseudocapsule as the anatomical landmark to enucleate the tumor by combining sharp and blunt dissection. Single layer suture technique was performed for renal reconstruction. The parenchymal defect was closed with horizontal interrupted 2-0 monocryl sutures with Hem-o-lok clips placed on the kidney capsule.

Results

In total, 299 patients underwent MRASE and 282 underwent MLSE. After matching, mean operative time and warm ischemic time was significantly lower in the MRASE than MLSE group (172.2 min vs.184.3 min; p=0.003 and 20.6 min vs. 25.2 min; p=0.000, respectively). The estimated blood loss was similar. Tumor bed suturing was performed in only 7.2% and 9.1% of MRASE and MLSE patients, respectively ( p=0.437). Postoperative complication rates were similar for MRASE and MLSE (8.7% vs. 13.0%, p=0.101). The incidence of positive surgical margins was comparable between the MRASE and MLSE group (1.4% vs. 1.8%, p=0.737). The decline in postoperative eGFR did not differ between the two groups (p=0.328). The median follow-up period was 13 (1-25) months for MRASE versus 30 (2-47) months for MLSE patients. Recurrence did not differ between the two groups (2.2% vs. 2.9%, p=0.588).

Conclusions

MRASE is a safe and acceptable alternative to MLSE, providing comparable morbidity and equivalent early oncological outcomes. MRASE appears to confer shorter operative time and warm ischemic time than MLSE. Moreover, MRASE is more likely to be used for complex renal tumors.

Funding

none