‘Trifecta’ outcomes of robot-assisted partial nephrectomy in solitary kidney: a Vattikuti Collective Quality Initiative (VCQI) database analysis

TY - JOUR

T1 - ‘Trifecta’ outcomes of robot-assisted partial nephrectomy in solitary kidney

T2 - a Vattikuti Collective Quality Initiative (VCQI) database analysis

AU - Arora, Sohrab

AU - Abaza, Ronney

AU - Adshead, James M.

AU - Ahlawat, Rajesh K.

AU - Challacombe, Benjamin J.

AU - Dasgupta, Prokar

AU - Gandaglia, Giorgio

AU - Moon, Daniel A.

AU - Yuvaraja, Thyavihally B.

AU - Capitanio, Umberto

AU - Larcher, Alessandro

AU - Porpiglia, Francesco

AU - Porter, James R.

AU - Mottrie, Alexander

AU - Bhandari, Mahendra

AU - Rogers, Craig

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objectives: To analyse the outcomes of robot-assisted partial nephrectomy (RAPN) in patients with a solitary kidney in a large multi-institutional database. Patients and Methods: In all, 2755 patients in the Vattikuti Collective Quality Initiative database underwent RAPN by 22 surgeons at 14 centres in nine countries. Of these patients, 74 underwent RAPN with a solitary kidney between 2007 and 2016. We retrospectively analysed the functional and oncological outcomes of these 74 patients. A ‘trifecta’ of outcomes was assessed, with trifecta defined as a warm ischaemia time (WIT) of <20 min, negative surgical margins, and no complications intraoperatively or within 3 months of RAPN. Results: All 74 patients underwent RAPN successfully with one conversion to radical nephrectomy. The median (interquartile range [IQR]) operative time was 180 (142–230) min. Early unclamping was used in 11 (14.9%) patients and zero ischaemia was used in 12 (16.2%). Trifecta outcomes were achieved in 38 of 66 patients (57.6%). The median (IQR) WIT was 15.5 (8.75–20.0) min for the entire cohort. The overall complication rate was 24.1% and the rate of Clavien–Dindo grade ≤II complications was 16.3%. Positive surgical margins were present in four cases (5.4%). The median (IQR) follow-up was 10.5 (2.12–24.0) months. The median drop in estimated glomerular filtration rate at 3 months was 7.0 mL/min/1.72 m2 (11.01%). Conclusion: Our findings suggest that RAPN is a safe and effective treatment option for select renal tumours in solitary kidneys in terms of a trifecta of negative surgical margins, WIT of <20 min, and low operative and perioperative morbidity.

AB - Objectives: To analyse the outcomes of robot-assisted partial nephrectomy (RAPN) in patients with a solitary kidney in a large multi-institutional database. Patients and Methods: In all, 2755 patients in the Vattikuti Collective Quality Initiative database underwent RAPN by 22 surgeons at 14 centres in nine countries. Of these patients, 74 underwent RAPN with a solitary kidney between 2007 and 2016. We retrospectively analysed the functional and oncological outcomes of these 74 patients. A ‘trifecta’ of outcomes was assessed, with trifecta defined as a warm ischaemia time (WIT) of <20 min, negative surgical margins, and no complications intraoperatively or within 3 months of RAPN. Results: All 74 patients underwent RAPN successfully with one conversion to radical nephrectomy. The median (interquartile range [IQR]) operative time was 180 (142–230) min. Early unclamping was used in 11 (14.9%) patients and zero ischaemia was used in 12 (16.2%). Trifecta outcomes were achieved in 38 of 66 patients (57.6%). The median (IQR) WIT was 15.5 (8.75–20.0) min for the entire cohort. The overall complication rate was 24.1% and the rate of Clavien–Dindo grade ≤II complications was 16.3%. Positive surgical margins were present in four cases (5.4%). The median (IQR) follow-up was 10.5 (2.12–24.0) months. The median drop in estimated glomerular filtration rate at 3 months was 7.0 mL/min/1.72 m2 (11.01%). Conclusion: Our findings suggest that RAPN is a safe and effective treatment option for select renal tumours in solitary kidneys in terms of a trifecta of negative surgical margins, WIT of <20 min, and low operative and perioperative morbidity.

KW - nephron-sparing surgery

KW - robot-assisted partial nephrectomy

KW - robotic partial nephrectomy

KW - robotic surgery

KW - solitary kidney

UR - http://www.scopus.com/inward/record.url?scp=85040324720&partnerID=8YFLogxK

U2 - 10.1111/bju.13967

DO - 10.1111/bju.13967

M3 - Article

AN - SCOPUS:85040324720

SN - 1464-4096

VL - 121

SP - 119

EP - 123

JO - BJU International

JF - BJU International

IS - 1

ER -