TORNA ALL’ELENCO

Perioperative morbidity of open, laparoscopic and robotic partial nephrectomy: A prospective multicenter observational study (RECORD 2) in European Urology, Supplements

2019
AOU San Luigi di Orbassano

Tipo pubblicazione

Conference Abstract

Autori/Collaboratori (24)Vedi tutti...

Bravi CA

Larcher A

Capitanio U


et alii...

Abstract

Introduction & Objectives: Surgical technique may affect the perioperative morbidity of partial nephrectomy. We aimed to compare the perioperative outcomes of open, laparoscopic and robotic partial nephrectomy in a prospective observational study. Materials & Methods: Data of 2,340 kidney cancer patients treated with NSS for cT1 renal tumors were extracted from the RECORd2 database, a prospective observational multicenter national-based collaborative project. We built a multivariable model to assess the relationship between surgical technique and surgical margins, ischemia time and postoperative complications. Moreover, we examined the probability to achieve a modified trifecta (negative margins, warm ischemia time <25 minutes and no Clavien-Dindo ?2 complications) for each surgical approach. Results: In the overall population, laparoscopic and robotic techniques were associated with significantly lower rate of Clavien-Dindo ?2 complications than that of open surgery (both p>0.059). The warm ischemia time was longer for the robotic technique when compared to open surgery (OR: 3.92; 95%CI: 2.59, 5.26; p<0.0001) and laparoscopy (OR: 2.61, 95%CI: 1.48, 3.75; p=0.0001). Positive margins rate did not differ between the groups (all p?0.06). The probability to achieve a positive trifecta was not affected by surgical technique in the overall population (all p?0.059). In PADUA <10 lesions, patients treated robotically had higher probability to achieve a positive trifecta when compared to those treated by open surgery (OR: 1.68; 95%CI: 1.10, 2.56; p=0.016) and laparoscopy (OR: 1.41; 95%CI: 0.99, 2.01; p=0.057). [Table presented] [Table presented] Models adjusted for age, gender, CCI, BMI, single kidney status, preoperative eGFR, clinical tumor stage, tumor side, total PADUA score, peritoneal approach, median annual caseload per center and year of surgery. OR: odds ratio. Cl: confidence interval. Conclusions: Robotic partial nephrectomy had lower perioperative m

DOI : 10.1016/S1569-9056(19)30332-X

Keywords

observational study; multicenter study; morbidity; male; major clinical study; laparoscopic surgery; kidney cancer; ischemia; human; gender; female; estimated glomerular filtration rate; disease course; controlled study; conference abstract; complication; cancer surgery; cancer staging; cancer patient; cancer model; body mass; adult; open surgery; partial nephrectomy; peritoneum; postoperative complication; preoperative evaluation; probability; prospective study; solitary kidney; surgery; surgical approach; surgical margin;