Presentation Authors: Chang Il Choi, Young Hyo Choi, Minyong Kang, Hyun Hwan Sung, Hwang Gyun Jeon, Byong Chang Jeong, Seong Soo Jeon, Hyun Moo Lee, Seong IL Seo, Jiwoong Yu*, Seoul , Korea, Republic of
Introduction: To compare and analyze surgical, oncological and functional outcomes of transperitoneal robotic partial nephrectomy (TRPN) and retroperitoneal RPN (RRPN).
Methods: Out of 566 consecutive renal cell carcinoma patients who underwent RPN by a single surgeon from December 2008 to July 2017, 523 patients (TRPN 310, RRPN 213) who evaluated preoperative and 1-year postoperative estimated glomerular filtration rate (eGFR) were analyzed. Primary endpoint was to compare Pentafecta criteria (negative surgical margin, no 30-day complication, warm ischemic time (WIT) â‰¤ 25 minutes, return of eGFR to >90% from baseline and no upstaging of chronic kidney disease) between TRPN and RRPN. Secondary endpoint was to find the factors associated with Pentafecta criteria.
Results: No significant difference was found in terms of age, body mass index, laterality, history of hypertension or diabetes, American Society of Anesthesiologists grade, tumor size and RENAL nephrometry score. Operative time, WIT and estimated blood loss (EBL) were lower in RRPN patients (p < 0.001, p = 0.008 and p < 0.003, respectively). Hospital stays, pre- and post-operative eGFRs and Pentafecta rates were not different. The rate of WIT â‰¤ 25 minutes was solely significantly different (p = 0.045) in the Pentafecta criteria (Table 1). No differences were found in perioperative and postoperative complications including blood transfusion and postoperative ileus (p = 0.629 and p = 0.274, respectively) between two approaches. There were four cases of recurrences after TRPN and no patient was recurred after RRPN, although RRPN patients had longer follow-up duration (median 25 vs. 36 months; p = 0.007). Multivariable analysis revealed tumor size and hospital stays as predictive for lack of Pentafecta (p < 0.001 for all, respectively) (Table 2).
Conclusions: RRPN demonstrated less operative time, WIT and EBL than TPRN. Pentafecta achievements were equivalent in both approaches. Tumor size and hospital stays were found as predictive factors of Pentafecta criteria.