Impact of Resection Technique on Perioperative Outcomes and Surgical Margins after Partial Nephrectomy for Localized Renal Masses: A Prospective Multicenter Study
Por:
Minervini, A, Campi, R, Lane, BR, De Cobelli, O, Sanguedolce, F, Hatzichristodoulou, G, Antonelli, A, Noyes, S, Mari, A, Rodriguez-Faba, O, Keeley, FX, Langenhuijsen, J, Musi, G, Klatte, T, Roscigno, M, Akdogan, B, Furlan, M, Karakoyunlu, N, Marszalek, M, Capitanio, U, Volpe, A, Brookman-May, S, Gschwend, JE, Smaldone, MC, Uzzo, RG, Carini, M, Kutikov, A
Publicada:
1 mar 2020
Resumen:
Purpose: The impact of resection technique on partial nephrectomy outcomes is controversial. The aim of this study was to evaluate the pattern of resection techniques during partial nephrectomy and the impact on perioperative outcomes, acute kidney injury, positive surgical margins and the achievement of the Trifecta (negative surgical margins, no perioperative Clavien-Dindo grade 2 or greater surgical complications and no postoperative acute kidney injury).
Materials and Methods: We prospectively collected data on consecutive patients with cT1-2N0M0 renal masses treated with partial nephrectomy at a total of 16 referral centers from September 2014 to March 2015. After partial nephrectomy the resection technique was classified by the surgeon as enucleation, enucleoresection or resection according to the SIB (Surface-Intermediate-Base) margin scores 0 to 2, 3 or 4 and 5, respectively. Multivariable logistic regression analysis was done to evaluate the potential impact of the resection technique on postoperative surgical complications, positive surgical margins, acute kidney injury and Trifecta achievement.
Results: Overall 507 patients were included in analysis. The resection technique was classified as enucleation in 266 patients (52%), enucleoresection in 150 (30%) and resection in 91 (18%). The resection technique (enucleoresection vs enucleation and resection) was the only significant predictor of positive surgical margins. Tumor complexity, surgical approach (open and laparoscopic vs robotic) and resection technique (enucleoresection vs enucleation) were significant predictors of Clavien-Dindo grade 2 or greater surgical complications. The surgical approach (open and laparoscopic vs robotic), the resection technique (enucleoresection vs enucleation) and warm ischemia time were significantly associated with postoperative acute kidney injury and Trifecta achievement.
Conclusions: Resection techniques significantly impact surgical complications, early functional outcomes and positive surgical margins after partial nephrectomy of localized renal masses.
Filiaciones:
Minervini, A:
Univ Florence, Dept Urol, Florence, Italy
Campi, R:
Univ Florence, Dept Urol, Florence, Italy
Lane, BR:
Spectrum Hlth Med Grp, Dept Urol, Grand Rapids, MI USA
De Cobelli, O:
Univ Milan, Dept Urol, European Inst Oncol IEO, Milan, Italy
Sanguedolce, F:
Southmead Hosp, Bristol Urol Inst, Bristol, Avon, England
Fundacio Puigvert, Urooncol Unit, Barcelona, Spain
Hatzichristodoulou, G:
Tech Univ Munich, Univ Hosp, Klinikum Rechts Isar, Dept Urol, Munich, Germany
Julius Maximilians Univ Wurzburg, Dept Urol & Pediat Urol, Wurzburg, Germany
Antonelli, A:
Univ Brescia, Dept Urol, Brescia, Italy
Noyes, S:
Spectrum Hlth Med Grp, Dept Urol, Grand Rapids, MI USA
Mari, A:
Univ Florence, Dept Urol, Florence, Italy
Rodriguez-Faba, O:
Fundacio Puigvert, Urooncol Unit, Barcelona, Spain
Keeley, FX:
Southmead Hosp, Bristol Urol Inst, Bristol, Avon, England
Langenhuijsen, J:
Radboud Univ Nijmegen, Nijmegen Med Ctr, Dept Urol, Nijmegen, Netherlands
Musi, G:
Univ Milan, Dept Urol, European Inst Oncol IEO, Milan, Italy
Klatte, T:
Royal Bournemouth Hosp, Bournemouth, Dorset, England
Med Univ Vienna, Vienna, Austria
Roscigno, M:
ASST Papa Giovanni XXIII, Bergamo, Italy
Akdogan, B:
Hacettepe Univ, Sch Med, Dept Urol, Ankara, Turkey
Furlan, M:
Univ Brescia, Dept Urol, Brescia, Italy
Karakoyunlu, N:
Diskapi Yildirim Beyazit Training & Res Hosp, Ankara, Turkey
Marszalek, M:
Graz Med Univ, Graz, Austria
Donauspital, Dept Urol & Androl, Vienna, Austria
Capitanio, U:
IRCCS Osped San Raffaele, URI, Div Expt Oncol, Unit Urol, Milan, Italy
Volpe, A:
Univ Piemonte Orientale, Maggiore Carita Hosp, Novara, Italy
Brookman-May, S:
Ludwig Maximilians Univ Munchen, Campus Grosshadern, Munich, Germany
Janssen Pharma Res & Dev, Los Angeles, CA USA
Gschwend, JE:
Tech Univ Munich, Univ Hosp, Klinikum Rechts Isar, Dept Urol, Munich, Germany
Smaldone, MC:
Fox Chase Canc Ctr, Div Urol Oncol, 7701 Burholme Ave, Philadelphia, PA 19111 USA
Uzzo, RG:
Fox Chase Canc Ctr, Div Urol Oncol, 7701 Burholme Ave, Philadelphia, PA 19111 USA
Carini, M:
Univ Florence, Dept Urol, Florence, Italy
Kutikov, A:
Fox Chase Canc Ctr, Div Urol Oncol, 7701 Burholme Ave, Philadelphia, PA 19111 USA
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