The continuous evolution of robotic assisted partial nephrectomy in complex renal tumours: a selection rather than a learning curve
BAUS ePoster online library. De Luyk N.
Jun 27, 2018; 211382
Disclosure(s): None
Mr. Nicolo De Luyk
Mr. Nicolo De Luyk
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Abstract
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Introduction & Objectives: Robotic assisted partial nephrectomy (RAPN) is the predominant method to treat small renal masses. We analysed our results looking at casemix with disease parameters and pertinent outcomes of both operative and oncological variables.

Methods: We reviewed our prospectively collated database of 352 RAPN performed sequentially between 2010 and 2017. Cases were divided into 3 cohorts. Variables included age, BMI, ASA, estimated GFR (eGFR), tumour size, PADUA score, operative time, blood loss, warm ischemic time (WIT), volume of healthy renal parenchyma loss and length of stay (LOS). The renal Trifecta was defined as WIT ≤25 minutes, negative surgical margins and absence of Clavien ≥3a complications. Pentafecta was defined as achievement of Trifecta with addition of over 90% eGFR preservation and no chronic kidney disease (CKD) stage upgrade. Results were analysed using non-parametric analysis.

Results: 300 cases were included (with full data) with clinical features below (Table 1). There was a steady increase in patient and tumour complexity while our Tri and Pentafecta rates increased over the cohorts.

Conclusion: Despite performing RAPN on more comorbid patients with greater BMI, poorer renal function, who have larger more complex lesions, the Trifecta and Pentafecta rates have climbed. LOS is shorter, renal function is maintained without a concomitant increase in WIT. In our experience this affirms the safety and feasibility of RAPN in more complex patients with more complex pathology.
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