Presentation Authors: Sohrab Arora*, Chandler Bronkema, Detroit, MI, James R Porter, Seattle, WA, Alexander Mottrie, Melle, Belgium, Mani Menon, Craig G Rogers, Wooju Jeong, Detroit, MI, Prokar dasgupta, London, United Kingdom, Koon H Rha, Seoul, Korea, Republic of, Rajesh K Ahlawat, Gurgaon, India, Umberto Capitanio, Milan, Italy, Thyavihally B Yuvaraja, Mumbai, India, Sudhir Rawal, New Delhi, India, Daniel A Moon, Melbourne, Australia, Ananthakrishnan Sivaraman, Chennai, India, Kris K Maes, Luz Saude, Portugal, Francesco Porpiglia, Torino, Italy, Gagan Gautam, New Delhi, India, Levent Turkeri, Istanbul, Turkey, Mahendra Bhandari, Firas Abdollah, Detroit, MI
Introduction: The technique of renal reconstruction after robotic partial nephrectomy (RPN) is a modifiable factor with a possible impact on ischemia time, postoperative bleeding, renal function, and incidence of pseudoaneurysms after surgery. We sought to evaluate the feasibility of omitting cortical (outer) renorrhaphy in a multi-institutional setting.
Methods: We analyzed the data of 1453 patients who underwent RPN, between 2006 and 2018, within the Vattikuti Collective Quality Initiative database that captures the data from 41 surgeons at 14 centers in 9 countries. Patients having surgery for bilateral tumors (n = 73) were excluded. Cortical renorrhaphy was omitted in 120 patients; 1260 patients underwent both inner (base) layer renorrhaphy and cortical renorrhaphy. The groups were compared in terms of operative time, ischemia time, blood loss, major (Clavien â‰¥ 3) complications, surgical margins, hospital stay, change in estimated glomerular filtration rate (eGFR), and need of angioembolization. Inverse probability of treatment weighting (IPTW) was performed to minimize selection bias by adjusting for age, gender, body mass index, tumor size, polar location, nephrometry score, American Society of Anesthesiologists score, comorbidities, access (retroperitoneal/transperitoneal), preoperative renal function, and center code. (Table 1)
Results: Operative and postoperative outcomes are summarized in Table 2. After IPTW, the weighted cohorts were not different in terms of operative time (p = 0.2), ischemia time (p = 0.7), blood loss (p = 0.6), change in eGFR (p = 0.9), intraoperative complications (p = 0.6), major postoperative complications (p = 0.1), positive surgical margins (p = 0.6), length of stay (p = 0.4), and the need for angioembolization (p = 0.4).
Conclusions: Omission of cortical renorrhaphy didnâ€™t significantly improve operative or ischemia time; however, it also had no adverse effect on perioperative outcomes after RPN in a multi-institutional setting.