Surgical Experience and Functional Outcomes after Laparoscopic and Robot-Assisted Partial Nephrectomy: Results from a Multi-Institutional Collaboration
Por:
Bravi, CA, Dell'Oglio, P, Pecoraro, A, Khene, ZE, Campi, R, Diana, P, Re, C, Giulioni, C, Beksac, AT, Bertolo, R, Ajami, T, Okhawere, K, Meagher, M, Alimohammadi, A, Borghesi, M, Mari, A, Amparore, D, Roscigno, M, Anceschi, U, Simone, G, Suardi, N, Galfano, A, Schiavina, R, Deho, F, Bensalah, K, Canda, AE, Ferrara, V, Alcaraz, A, Zhang, X, Terrone, C, Shariat, S, Porpiglia, F, Antonelli, A, Kaouk, J, Badani, K, Minervini, A, Derweesh, I, Breda, A, Mottrie, A, Montorsi, F, Larcher, A
Publicada:
1 oct 2024
Resumen:
Background: In patients treated with partial nephrectomy, prior evidence showed that peri-operative outcomes, such as complications and ischemia time, improved as a function of the surgical experience of the surgeon, but data on functional outcomes after surgery are still scarce. Methods: We retrospectively analyzed data of 4011 patients with a single, unilateral cT1a-b renal mass treated with laparoscopic or robot-assisted partial nephrectomy. The operations were performed by 119 surgeons at 22 participating institutions between 1997 and 2022. Multivariable models investigated the association between surgical experience (number of prior operations) and acute kidney injury (AKI) and recovery of at least 90% of baseline estimated glomerular filtration rate (eGFR) 1 yr after partial nephrectomy. The adjustment for case mix included age, Body Mass Index, preoperative serum creatinine, clinical T stage, PADUA score, warm ischemia time, pathologic tumor size, and year of surgery. Results: A total of 753 (19%) and 3258 (81%) patients underwent laparoscopic and robot-assisted partial nephrectomy, respectively. Overall, 37 (31%) and 55 (46%) surgeons contributed only to laparoscopic and robotic learning curves, respectively, whereas 27 (23%) contributed to the learning curves of both approaches. In the laparoscopic group, 8% and 55% of patients developed AKI and recovered at least 90% of their baseline eGFR, respectively. After adjusting for confounders, we did not find evidence of an association between surgical experience and AKI after laparoscopic partial nephrectomy (odds ratio [OR]: 0.9992; 95% confidence interval [CI]: 0.9963, 1.0022; p = 0.6). Similar results were found when 1-year renal function was the outcome of interest (OR: 0.9996; 95% CI: 0.9988, 1.0005; p = 0.5). Among patients who underwent robot-assisted partial nephrectomy, AKI occurred in 11% of patients, whereas 54% recovered at least 90% of their baseline eGFR. On multivariable analyses, the relationship between surgical experience and AKI after surgery was not statistically significant (OR: 1.0015; 95% CI: 0.9992, 1.0037; p = 0.2), with similar results when the outcome of interest was renal function one year after surgery (OR: 1.0001; 95% CI: 0.9980, 1.0022; p = 0.9). Virtually the same findings were found on sensitivity analyses. Conclusions: In patients treated with laparoscopic or robot-assisted partial nephrectomy, our data suggest that the surgical experience of the operating surgeon might not be a key determinant of functional recovery after surgery. This raises questions about the use of serum markers to assess functional recovery in patients with two kidneys and opens the discussion on what are the key steps of the procedure that allowed surgeons to achieve optimal outcomes since their initial cases.
Filiaciones:
Bravi, CA:
Royal Marsden NHS Fdn Trust, Dept Urol, London SW3 6JJ, England
Onze Lieve Vrouwziekenhuis Hosp, Dept Urol, B-9300 Aalst, Belgium
ORSI Acad, B-9090 Ghent, Belgium
IRCCS Osped San Raffaele, Div Oncol, Unit Urol, URI, I-20132 Milan, Italy
Dell'Oglio, P:
ASST Grande Osped Metropolitano Niguarda, Dept Urol, I-20162 Milan, Italy
Antoni Van Leeuwenhoek Hosp, Netherlands Canc Inst, Dept Urol, NL-1066 CX Amsterdam, Netherlands
Leiden Univ, Med Ctr, Dept Radiol, Intervent Mol Imaging Lab, NL-2333 ZA Leiden, Netherlands
Pecoraro, A:
Hosp Pederzoli, Dept Urol, I-37019 Peschiera Del Garda, Verona, Italy
Khene, ZE:
Univ Rennes, Dept Urol, F-35700 Rennes, France
Campi, R:
Univ Florence, Careggi Hosp, Dept Expt & Clin Med, Unit Urol Robot Surg & Renal Transplantat, I-50134 Florence, Italy
Diana, P:
Univ Autonoma Barcelona, Dept Urol, Fundacio Puigvert, Barcelona 08025, Spain
Re, C:
IRCCS Osped San Raffaele, Div Oncol, Unit Urol, URI, I-20132 Milan, Italy
Univ Insubria, ASST Sette Laghi Circolo & Fdn Macchi Hosp, I-21100 Varese, Italy
Giulioni, C:
Jesi Hosp, Unit Urol, I-60035 Jesi, Ancona, Italy
Polytech Univ Marche Reg, Dept Urol, I-60121 Ancona, Italy
Beksac, AT:
Cleveland Clin, Glickman Urol & Kidney Inst, Cleveland, OH 44106 USA
Bertolo, R:
San Carlo Nancy Hosp, Dept Urol, I-00165 Rome, Italy
Ajami, T:
Univ Barcelona, Hosp Clin, Dept Urol, IDIBAPS, Barcelona 08036, Spain
Okhawere, K:
Icahn Sch Med Mt Sinai, Dept Urol, New York, NY 10029 USA
Meagher, M:
Univ Calif La Jolla, Dept Urol, San Diego, CA 92103 USA
Alimohammadi, A:
Med Univ Vienna, Dept Urol, A-1090 Vienna, Austria
Borghesi, M:
Univ Genoa, Dept Surg & Diagnost Integrated Sci DISC, I-16132 Genoa, Italy
Mari, A:
Univ Florence, Careggi Hosp, Dept Clin & Expt Med, Unit Oncol Minimally Invas Urol & Androl, I-50134 Florence, Italy
Amparore, D:
Univ Turin, San Luigi Gonzaga Hosp, Dept Oncol, Div Urol, I-10043 Turin, Italy
Roscigno, M:
ASST Papa Giovanni XXIII, I-24125 Bergamo, Italy
Univ Milano Bicocca, Sch Med, I-20132 Milan, Italy
Anceschi, U:
IRCCS Regina Elena Natl Canc Inst, Dept Urol, I-00128 Rome, Italy
Simone, G:
IRCCS Regina Elena Natl Canc Inst, Dept Urol, I-00128 Rome, Italy
Suardi, N:
Univ Brescia, Dept Urol, I-25123 Brescia, Italy
Galfano, A:
ASST Grande Osped Metropolitano Niguarda, Dept Urol, I-20162 Milan, Italy
Schiavina, R:
IRCCS Azienda Osped Univ Bologna, Div Urol, I-40138 Bologna, Italy
Deho, F:
Univ Insubria, ASST Sette Laghi Circolo & Fdn Macchi Hosp, I-21100 Varese, Italy
Bensalah, K:
Univ Rennes, Dept Urol, F-35700 Rennes, France
Canda, AE:
Koc Univ Hosp, Dept Urol, TR-34010 Istanbul, Turkiye
Rahmi M Koc Acad Intervent Med Educ & Simulat, RMK AIMES, TR-34010 Istanbul, Turkiye
Ferrara, V:
Jesi Hosp, Unit Urol, I-60035 Jesi, Ancona, Italy
Alcaraz, A:
Univ Barcelona, Hosp Clin, Dept Urol, IDIBAPS, Barcelona 08036, Spain
Zhang, X:
Chinese Peoples Liberat Army Gen Hosp, Dept Urol, Beijing 100091, Peoples R China
Terrone, C:
Univ Genoa, Dept Surg & Diagnost Integrated Sci DISC, I-16132 Genoa, Italy
Shariat, S:
Med Univ Vienna, Dept Urol, A-1090 Vienna, Austria
Sechenov Univ, Inst Urol & Reprod Hlth, Moscow 119435, Russia
Porpiglia, F:
Univ Turin, San Luigi Gonzaga Hosp, Dept Oncol, Div Urol, I-10043 Turin, Italy
Antonelli, A:
Univ Verona, Dept Urol, Azienda Osped Univ Integrata, I-37126 Verona, Italy
Kaouk, J:
Cleveland Clin, Glickman Urol & Kidney Inst, Cleveland, OH 44106 USA
Badani, K:
Icahn Sch Med Mt Sinai, Dept Urol, New York, NY 10029 USA
Minervini, A:
Univ Florence, Careggi Hosp, Dept Clin & Expt Med, Unit Oncol Minimally Invas Urol & Androl, I-50134 Florence, Italy
Derweesh, I:
Univ Calif La Jolla, Dept Urol, San Diego, CA 92103 USA
Breda, A:
Univ Autonoma Barcelona, Dept Urol, Fundacio Puigvert, Barcelona 08025, Spain
Mottrie, A:
Onze Lieve Vrouwziekenhuis Hosp, Dept Urol, B-9300 Aalst, Belgium
ORSI Acad, B-9090 Ghent, Belgium
Montorsi, F:
IRCCS Osped San Raffaele, Div Oncol, Unit Urol, URI, I-20132 Milan, Italy
Larcher, A:
IRCCS Osped San Raffaele, Div Oncol, Unit Urol, URI, I-20132 Milan, Italy
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