Abstract: PD20-10
Sources of Funding: None

Introduction

Partial nephrectomy is standard of care for renal tumors up to 7 cm and there is a widespread use of the minimal invasive approach since the introduction of robot-assisted surgery. However, there might still be some reservations in complex tumor constellations. Our study aims to demonstrate that robot-assisted partial nephrectomy (RAPN) provides good results for high risk tumors in comparison with less complex renal masses._x000D_

Methods

Since 2008, 538 robot-assisted partial nephrectomies were performed at Missionsaerztliche Klinik, Wuerzburg (n=361), St. Antonius Hospital, Gronau (n=60), and Augusta-Kranken-Anstalt Bochum (n=117). To assess functional and oncological outcome, both MIC criteria (negative margins, ischemia time < 20 minutes, no major complications) as well as the Trifecta (negative surgical margins, WIT < 25 minutes, no complications) were applied. _x000D_

Results

60,6% of the tumors were of low and intermediate complexity (PADUA score 6-7, n=123, score 8-9, n=203, group A) while 39,4% were highly complex (score 10-12, B). There were no significant differences in ASA score or BMI. Median clinical tumor size was 28 in the low vs. 37 mm in in the high complexity group (p<0,001). While there was no significantly prolonged skin-skin time (160 vs. 163 minutes, p=0,17), ischemia time was shorter for tumors of low and intermediate complexity (11 vs. 12 minutes, p<0,001). More intraoperative transfusions were necessary in the high risk group (0 vs. 3, p=0,06). Neither intra- (3,4 vs. 6,6%) nor postoperative (Clavien-Dindo, 21% vs. 25%, p=0,3) complication rates showed significant differences between both groups. On postoperative day 1, a median decrease of hemoglobin of -2,4 g/dl was found in B vs. -2,2 g/dl (p=0,042) in group A. There was a median creatinine increase of 0,10 vs. 0,17 mg/dl (p<0,001) and loss of eGFR of 9,4 vs. 15,1 ml/min (p<0,001) on demission. Benign tumors were found in 26% of the patients with low/intermediate-risk lesions vs. 21% in the high complexity group. In 3% of high complexity tumors a positive surgical margin (R1) with 3% Rx vs. 2% and 2% for A was found (p=0,29). MIC criteria could be achieved in 82% (A) vs. 76% (B, p=0,80) and Trifecta criteria in 74% (A) vs. 69% (B, p=0,20).

Conclusions

Significant differences between high and low complexity groups could only be identified in ischemia time and renal function. However, complication rates as well as quality criteria as indicated by MIC and Trifecta were similar in both groups. Therefore, RAPN is a very good therapeutic option also in highly complex tumors.

Funding

None