An International Delphi Consensus About Tumor Rupture During Robotic Partial Nephrectomy (Researching UnPredictable TUmor RupturE during Robotic Partial Nephrectomy-The RUPTURE Project)
Por:
Bertolo, R, Antonelli, A, Bex, A, Anderson, C, Autorino, R, Barber, N, Badani, K, Barod, R, Bensalah, K, Bernhard, JC, Breda, A, Capitanio, U, Challacombe, B, Crivellaro, S, De Groote, R, Derweesh, I, Galfano, A, Harke, N, Kaouk, J, Kutikov, A, Maes, K, Minervini, A, Maresma, MCM, Montorsi, F, Porpiglia, F, Porter, J, Schiavina, R, Siemer, S, Simone, G, Touijer, K, Vaessen, C, Volpe, A, Wu, ZJ, Zondervan, P, Russo, P, Ribal, MJ, Mottrie, A
Publicada:
1 sep 2025
Ahead of Print:
1 sep 2025
Resumen:
Background and objective: Tumor rupture during robot-assisted partial nephrectomy (RAPN) poses oncological risks, including potential malignant cell spread and recurrence. Despite these risks, standardized guidelines for defining, managing, and assessing risk factors of tumor rupture in RAPN are lacking. This Delphi consensus study aimed to frame the definition, risk factors, and oncological implications of tumor rupture in RAPN, as well as to propose management strategies. Methods: Using a modified Delphi method, a steering committee from multiple urological societies (the RUPTURE project) led a consensus-building study that followed the ACcurate COnsensus Reporting Document (ACCORD) checklist. A panel of international experts participated in a two-phase Delphi survey, rating their agreement with statements on tumor rupture, risk factors, and management in RAPN. Consensus was defined as >= 70% agreement, with unresolved statements discussed in an online meeting and subjected to a second voting round. Key findings and limitations: Thirty-three experts evaluated 58 statements. Consensus was reached on 33% of statements in the first round and 37.5% in the second round. Tumor rupture was defined, with risk factors including larger tumor size, complexity, and endophytic growth patterns. Recommended management strategies focused on minimizing tumor spillage by suctioning-rather than grasping-the cancerous tissue, and promptly securing the specimen in an endobag. Routine conversion to radical nephrectomy was not advised unless unresectable tumor remnants were found. Tumor rupture was not linked to distant metastasis, although its oncological impact varied by the rupture extent (ie, gross rupture vs focal; tumor spilled out macroscopically completely removed vs not). Conclusions and clinical implications: This consensus forms a basis for future research on tumor rupture in RAPN, emphasizing standardized definitions and uniform management strategies. Empirical validation through future clinical research is warranted. Patient summary: This research looks at tumor rupture during robotic kidney surgery, which can happen but is rare. The study involved a panel of experts who discussed finding a consensus on when it is more likely to occur and how to manage it effectively to reduce risks. It was also emphasized that while a rupture may not always lead to cancer spreading, the impact on a patient's health can vary and is yet to be determined. (c) 2025 The Authors. Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY-NC-ND license (http://creative-commons.org/licenses/by-nc-nd/4.0/).
Filiaciones:
Bertolo, R:
Univ Verona, Azienda Osped Univ Integrata, Borgo Trento Hosp, Dept Urol, Verona, Italy
Antonelli, A:
Univ Verona, Azienda Osped Univ Integrata, Borgo Trento Hosp, Dept Urol, Verona, Italy
Bex, A:
UCL, Royal Free London NHS Fdn Trust, Dept Urol, London, England
Netherlands Canc Inst, Amsterdam, Netherlands
Anderson, C:
St George Hosp, Dept Urol, London, England
Autorino, R:
Rush Univ, Med Ctr, Dept Urol, Chicago, IL USA
Barber, N:
Frimley NHS Fdn Trust, Urol Dept, Camberley, England
Badani, K:
Icahn Sch Med Mt Sinai, New York, NY USA
Barod, R:
UCL, Royal Free London NHS Fdn Trust, Dept Urol, London, England
Bensalah, K:
Univ Rennes, Dept Urol, Rennes, France
Bernhard, JC:
CHU Bordeaux, Dept Urol, Bordeaux, France
Breda, A:
Autonoma Univ Barcelona, Dept Urol, Fundacio Puigvert, Barcelona, Spain
Capitanio, U:
IRCCS San Raffaele Sci Inst, Urol Res Inst URI, Milan, Italy
Challacombe, B:
Guys & St ThomasNHS Fdn Trust, London, England
Crivellaro, S:
Univ Illinois, Dept Urol, Chicago, IL USA
De Groote, R:
Onze Lieve Vrouw Hosp, Dept Urol, Aalst, Belgium
ORSI Acad, Melle, Belgium
Derweesh, I:
UC San Diego Hlth Syst, Dept Urol, La Jolla, CA USA
Galfano, A:
Osped Niguarda Ca Granda, Dept Urol, Milan, Italy
Harke, N:
Hannover Med Sch, Dept Urol, Hannover, Germany
Kaouk, J:
Glickman Urol & Kidney Inst, Cleveland Clin, Cleveland Hts, OH USA
Kutikov, A:
Fox Chase Canc Ctr, Dept Surg Oncol, Div Urol Oncol, Philadelphia, PA USA
Maes, K:
Hosp Luz Lisboa, Dept Urol, Lisbon, Portugal
Minervini, A:
Univ Florence, Careggi Hosp, Dept Expt & Clin Med, Unit Oncol Minimally Invas Urol & Androl, Florence, Italy
Maresma, MCM:
Fdn Invest Hosp IMED Valencia, Serv Urol, Valencia, Spain
Montorsi, F:
IRCCS San Raffaele Sci Inst, Urol Res Inst URI, Milan, Italy
Porpiglia, F:
Univ Turin, San Luigi Gonzaga Hosp, Sch Med, Dept Oncol, Turin, Italy
Porter, J:
Swedish Med Ctr, Swedish Urol Grp, Seattle, WA USA
Schiavina, R:
IRCCS Azienda Osped Univ Bologna, Div Urol, Bologna, Italy
Siemer, S:
St Antonius Hosp, Dept Urol, Urol Oncol & Robotassisted Surg, Gronau, Germany
Simone, G:
IRCCS Regina Elena Natl Canc Inst, Dept Urol, Rome, Italy
Touijer, K:
Mem Sloan Kettering Canc Ctr, Dept Surg, Urol Serv, New York, NY USA
Vaessen, C:
Sorbonne Univ, Pitie Salpetriere Hop, AP HP, Urol,GRC 5, Paris, France
Volpe, A:
Univ Piemonte Orientale, Dept Translat Med, Div Urol, Novara, Italy
Wu, ZJ:
Naval Med Univ, Changhai Hosp, Dept Urol, Shanghai, Peoples R China
Zondervan, P:
Univ Amsterdam, Amsterdam Univ, Canc Ctr Amsterdam, Dept Urol,Med Ctr, Amsterdam, Netherlands
Russo, P:
Mem Sloan Kettering Canc Ctr, Dept Surg, Urol Serv, New York, NY USA
Ribal, MJ:
Hosp Clin Barcelona, Dept Urol, Barcelona, Spain
Mottrie, A:
Onze Lieve Vrouw Hosp, Dept Urol, Aalst, Belgium
ORSI Acad, Melle, Belgium
Green Submitted, gold
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