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Minerva Urologica e Nefrologica 2020 Nov 17

DOI: 10.23736/S0393-2249.20.04151-X

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Robot-assisted partial nephrectomy: 7-year outcomes

Umberto CARBONARA 1, 2, Giuseppe SIMONE 3, Umberto CAPITANIO 4, 5, Andrea MINERVINI 6, Cristian FIORI 7, Alessandro LARCHER 4, 5, Enrico CHECCUCCI 7, Daniele AMPARORE 7, Fabio CROCEROSSA 1, Alessandro VECCIA 1, Samuel WEPRIN 1, Pasquale DITONNO 2, 8, Aldo BRASSETTI3, Alfredo BOVE 3, Andrea MARI 6, Antonio A. GROSSO 6, Marco CARINI 6, Francesco MONTORSI 4, 5, Lance J. HAMPTON 1, Michele GALLUCCI 9, Francesco PORPIGLIA 7, Riccardo AUTORINO 1

1 Division of Urology, VCU Health, Richmond, VA, USA; 2 Department of Urology, University of Bari, Bari, Italy; 3 Department of Urology, Regina Elena Institute, Rome, Italy; 4 Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy; 5 Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy; 6 Department of Urology, Carreggi Hospital, University of Florence, Florence, Italy; 7 Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy;8 Unit of Urology, National Cancer Institute IRCCS Giovanni Paolo II, Bari, Italy; 9 Department of Urology, Sapienza University, Rome, Italy


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BACKGROUND: The role of robot-assisted partial nephrectomy (RAPN) in the management of renal masses has exponentially grown over the past 10 years. Nevertheless, data on long term outcomes of the procedure remains limited. Herein we report oncological and functional outcomes of patients who underwent RAPN for a malignant mass with a median follow-up of 7-yr, the longest follow-up to date.
METHODS: A retrospective analysis of an international multicenter database was performed. All consecutive patients undergoing surgery between 2009 and 2013 with a minimum of 3-yr follow-up and complete data on renal function were included. Demographics, surgical and perioperative outcomes were analyzed. Overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) were evaluated using Kaplan-Meier analysis.
RESULTS: Overall, our study cohort was composed of eighty-five patients with a median follow-up of 88mo. Median clinical tumor size was 3cm, with mostly (74.1%) clinical stage T1a, and median R.E.N.A.L. score 6. Final histopathologic analysis revealed clear cell RCC in 76.5% of cases. PSM was present in 7 patients (8.2%). Eleven overall deaths (12.9%) occurred in the cohort during the follow-up period. Two of these (2.33%) were attributed to metastatic RCC. The OS, CSS, and DFS rates were 91.7, 97.7, and 91.7% at 84mo, respectively. Regarding the renal functional outcomes, seventeen patients (20.1%) presented a CKD upstaging in our cohort.
CONCLUSIONS: Our findings show excellent 7-year oncologic and functional outcomes of the procedure, which duplicate those achieved in historical series of open and laparoscopic surgery.


KEY WORDS: Nephron sparing surgery; Robotic partial nephrectomy; Long-term outcomes

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