Perioperative outcomes following robot-assisted partial nephrectomy in elderly patients

Gopal Sharma; Milap Shah; Puneet Ahluwalia; Prokar Dasgupta; Benjamin J. Challacombe; Mahendra Bhandari; Rajesh Ahlawat; Sudhir Rawal; Nicolo M. Buffi; Ananthakrishanan Sivaraman; James R. Porter; Craig Rogers; Alexandre Mottrie; Ronney Abaza; Khoon Ho Rha; Daniel Moon; Thyavihally B. Yuvaraja; Dipen J. Parekh; Umberto Capitanio; Kris K. Maes; Francesco Porpiglia; Levent Turkeri; Gagan Gautam

doi:10.1007/s00345-022-04171-4

Perioperative outcomes following robot-assisted partial nephrectomy in elderly patients

Gopal Sharma, Milap Shah, Puneet Ahluwalia, Prokar Dasgupta, Benjamin J. Challacombe, Mahendra Bhandari, Rajesh Ahlawat, Sudhir Rawal, Nicolo M. Buffi, Ananthakrishanan Sivaraman, James R. Porter, Craig Rogers, Alexandre Mottrie, Ronney Abaza, Khoon Ho Rha, Daniel Moon, Thyavihally B. Yuvaraja, Dipen J. Parekh, Umberto Capitanio, Kris K. MaesFrancesco Porpiglia, Levent Turkeri, Gagan Gautam^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Objective: To compare perioperative outcomes following robot-assisted partial nephrectomy (RAPN) in patients with age ≥ 70 years to age < 70 years. Methods: Using Vattikuti Collective quality initiative (VCQI) database for RAPN we compared perioperative outcomes following RAPN between the two age groups. Primary outcome of the study was to compare trifecta outcomes between the two groups. Propensity matching using nearest neighbourhood method was performed with trifecta as primary outcome for sex, body mass index (BMI), solitary kidney, tumor size and Renal nephrometery score (RNS). Results: Group A (age ≥ 70 years) included 461 patients whereas group B included 1932 patients. Before matching the two groups were statistically different for RNS and solitary kidney rates. After propensity matching, the two groups were comparable for baselines characteristics such as BMI, tumor size, clinical symptoms, tumor side, face of tumor, solitary kidney and tumor complexity. Among the perioperative outcome parameters there was no difference between two groups for operative time, blood loss, intraoperative transfusion, intraoperative complications, need for radical nephrectomy, positive margins and trifecta rates. Warm ischemia time was significantly longer in the younger age group (18.1 min vs. 16.3 min, p = 0.003). Perioperative complications were significantly higher in the older age group (11.8% vs. 7.7%, p = 0.041). However, there was no difference between the two groups for major complications. Conclusion: RAPN in well-selected elderly patients is associated with comparable trifecta outcomes with acceptable perioperative morbidity.

Original language	English
Pages (from-to)	2789-2798
Number of pages	10
Journal	World Journal of Urology
Volume	40
Issue number	11
Early online date	6 Oct 2022
DOIs	https://doi.org/10.1007/s00345-022-04171-4
Publication status	Published - Nov 2022

Keywords

Elderly
Partial nephrectomy
Propensity-matching
Robotic

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10.1007/s00345-022-04171-4

Perioperative outcomes following_SHARMA_Accepted23September2022_GREEN AAM
This version of the article has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: http://dx.doi.org/10.1007/s00345-022-04171-4
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Sharma, G., Shah, M., Ahluwalia, P., Dasgupta, P., Challacombe, B. J., Bhandari, M., Ahlawat, R., Rawal, S., Buffi, N. M., Sivaraman, A., Porter, J. R., Rogers, C., Mottrie, A., Abaza, R., Rha, K. H., Moon, D., Yuvaraja, T. B., Parekh, D. J., Capitanio, U., ... Gautam, G. (2022). Perioperative outcomes following robot-assisted partial nephrectomy in elderly patients. World Journal of Urology, 40(11), 2789-2798. https://doi.org/10.1007/s00345-022-04171-4

@article{15e530baab204e769590637b49e13a8b,

title = "Perioperative outcomes following robot-assisted partial nephrectomy in elderly patients",

abstract = "Objective: To compare perioperative outcomes following robot-assisted partial nephrectomy (RAPN) in patients with age ≥ 70 years to age < 70 years. Methods: Using Vattikuti Collective quality initiative (VCQI) database for RAPN we compared perioperative outcomes following RAPN between the two age groups. Primary outcome of the study was to compare trifecta outcomes between the two groups. Propensity matching using nearest neighbourhood method was performed with trifecta as primary outcome for sex, body mass index (BMI), solitary kidney, tumor size and Renal nephrometery score (RNS). Results: Group A (age ≥ 70 years) included 461 patients whereas group B included 1932 patients. Before matching the two groups were statistically different for RNS and solitary kidney rates. After propensity matching, the two groups were comparable for baselines characteristics such as BMI, tumor size, clinical symptoms, tumor side, face of tumor, solitary kidney and tumor complexity. Among the perioperative outcome parameters there was no difference between two groups for operative time, blood loss, intraoperative transfusion, intraoperative complications, need for radical nephrectomy, positive margins and trifecta rates. Warm ischemia time was significantly longer in the younger age group (18.1 min vs. 16.3 min, p = 0.003). Perioperative complications were significantly higher in the older age group (11.8% vs. 7.7%, p = 0.041). However, there was no difference between the two groups for major complications. Conclusion: RAPN in well-selected elderly patients is associated with comparable trifecta outcomes with acceptable perioperative morbidity.",

keywords = "Elderly, Partial nephrectomy, Propensity-matching, Robotic",

author = "Gopal Sharma and Milap Shah and Puneet Ahluwalia and Prokar Dasgupta and Challacombe, {Benjamin J.} and Mahendra Bhandari and Rajesh Ahlawat and Sudhir Rawal and Buffi, {Nicolo M.} and Ananthakrishanan Sivaraman and Porter, {James R.} and Craig Rogers and Alexandre Mottrie and Ronney Abaza and Rha, {Khoon Ho} and Daniel Moon and Yuvaraja, {Thyavihally B.} and Parekh, {Dipen J.} and Umberto Capitanio and Maes, {Kris K.} and Francesco Porpiglia and Levent Turkeri and Gagan Gautam",

note = "Funding Information: Vattikuti Foundation for providing data. The authors would also like to thank Mrs. Tanvi Sharma (M Phil English) for English language editing Publisher Copyright: {\textcopyright} 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.",

year = "2022",

month = nov,

doi = "10.1007/s00345-022-04171-4",

language = "English",

volume = "40",

pages = "2789--2798",

journal = "World Journal of Urology",

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Sharma, G, Shah, M, Ahluwalia, P, Dasgupta, P , Challacombe, BJ, Bhandari, M, Ahlawat, R, Rawal, S, Buffi, NM, Sivaraman, A, Porter, JR, Rogers, C, Mottrie, A, Abaza, R, Rha, KH, Moon, D, Yuvaraja, TB, Parekh, DJ, Capitanio, U, Maes, KK, Porpiglia, F, Turkeri, L & Gautam, G 2022, 'Perioperative outcomes following robot-assisted partial nephrectomy in elderly patients', World Journal of Urology, vol. 40, no. 11, pp. 2789-2798. https://doi.org/10.1007/s00345-022-04171-4

TY - JOUR

T1 - Perioperative outcomes following robot-assisted partial nephrectomy in elderly patients

AU - Sharma, Gopal

AU - Shah, Milap

AU - Ahluwalia, Puneet

AU - Dasgupta, Prokar

AU - Challacombe, Benjamin J.

AU - Bhandari, Mahendra

AU - Ahlawat, Rajesh

AU - Rawal, Sudhir

AU - Buffi, Nicolo M.

AU - Sivaraman, Ananthakrishanan

AU - Porter, James R.

AU - Rogers, Craig

AU - Mottrie, Alexandre

AU - Abaza, Ronney

AU - Rha, Khoon Ho

AU - Moon, Daniel

AU - Yuvaraja, Thyavihally B.

AU - Parekh, Dipen J.

AU - Capitanio, Umberto

AU - Maes, Kris K.

AU - Porpiglia, Francesco

AU - Turkeri, Levent

AU - Gautam, Gagan

N1 - Funding Information: Vattikuti Foundation for providing data. The authors would also like to thank Mrs. Tanvi Sharma (M Phil English) for English language editing Publisher Copyright: © 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

PY - 2022/11

Y1 - 2022/11

N2 - Objective: To compare perioperative outcomes following robot-assisted partial nephrectomy (RAPN) in patients with age ≥ 70 years to age < 70 years. Methods: Using Vattikuti Collective quality initiative (VCQI) database for RAPN we compared perioperative outcomes following RAPN between the two age groups. Primary outcome of the study was to compare trifecta outcomes between the two groups. Propensity matching using nearest neighbourhood method was performed with trifecta as primary outcome for sex, body mass index (BMI), solitary kidney, tumor size and Renal nephrometery score (RNS). Results: Group A (age ≥ 70 years) included 461 patients whereas group B included 1932 patients. Before matching the two groups were statistically different for RNS and solitary kidney rates. After propensity matching, the two groups were comparable for baselines characteristics such as BMI, tumor size, clinical symptoms, tumor side, face of tumor, solitary kidney and tumor complexity. Among the perioperative outcome parameters there was no difference between two groups for operative time, blood loss, intraoperative transfusion, intraoperative complications, need for radical nephrectomy, positive margins and trifecta rates. Warm ischemia time was significantly longer in the younger age group (18.1 min vs. 16.3 min, p = 0.003). Perioperative complications were significantly higher in the older age group (11.8% vs. 7.7%, p = 0.041). However, there was no difference between the two groups for major complications. Conclusion: RAPN in well-selected elderly patients is associated with comparable trifecta outcomes with acceptable perioperative morbidity.

AB - Objective: To compare perioperative outcomes following robot-assisted partial nephrectomy (RAPN) in patients with age ≥ 70 years to age < 70 years. Methods: Using Vattikuti Collective quality initiative (VCQI) database for RAPN we compared perioperative outcomes following RAPN between the two age groups. Primary outcome of the study was to compare trifecta outcomes between the two groups. Propensity matching using nearest neighbourhood method was performed with trifecta as primary outcome for sex, body mass index (BMI), solitary kidney, tumor size and Renal nephrometery score (RNS). Results: Group A (age ≥ 70 years) included 461 patients whereas group B included 1932 patients. Before matching the two groups were statistically different for RNS and solitary kidney rates. After propensity matching, the two groups were comparable for baselines characteristics such as BMI, tumor size, clinical symptoms, tumor side, face of tumor, solitary kidney and tumor complexity. Among the perioperative outcome parameters there was no difference between two groups for operative time, blood loss, intraoperative transfusion, intraoperative complications, need for radical nephrectomy, positive margins and trifecta rates. Warm ischemia time was significantly longer in the younger age group (18.1 min vs. 16.3 min, p = 0.003). Perioperative complications were significantly higher in the older age group (11.8% vs. 7.7%, p = 0.041). However, there was no difference between the two groups for major complications. Conclusion: RAPN in well-selected elderly patients is associated with comparable trifecta outcomes with acceptable perioperative morbidity.

KW - Elderly

KW - Partial nephrectomy

KW - Propensity-matching

KW - Robotic

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DO - 10.1007/s00345-022-04171-4

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AN - SCOPUS:85139470717

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VL - 40

SP - 2789

EP - 2798

JO - World Journal of Urology

JF - World Journal of Urology

IS - 11

ER -

Perioperative outcomes following robot-assisted partial nephrectomy in elderly patients

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