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Robot-assisted partial nephrectomy for high-complexity tumors (PADUA score ≥10): Perioperative, long-term functional and oncologic outcomes

Authors
 Periklis Koukourikis  ;  Ali Abdullah Alqahtani  ;  Ahmad Almujalhem  ;  Jongsoo Lee  ;  Woong Kyu Han  ;  Koon Ho Rha 
Citation
 INTERNATIONAL JOURNAL OF UROLOGY, Vol.28(5) : 554-559, 2021-05 
Journal Title
INTERNATIONAL JOURNAL OF UROLOGY
ISSN
 0919-8172 
Issue Date
2021-05
MeSH
Glomerular Filtration Rate ; Humans ; Kidney Neoplasms* / surgery ; Nephrectomy / adverse effects ; Postoperative Complications / epidemiology ; Postoperative Complications / etiology ; Retrospective Studies ; Robotic Surgical Procedures* / adverse effects ; Robotics* ; Treatment Outcome
Keywords
PADUA score ; kidney neoplasms ; partial nephrectomy ; renal cell cancer ; robotic surgical procedures
Abstract
Objectives: To evaluate the safety and efficacy, and long-term functional and oncologic outcomes of robot-assisted partial nephrectomy in high-complexity tumors.

Methods: Data of 155 patients with a high-complexity tumor (PADUA score ≥10) were reviewed. Trifecta achievement, intra-, perioperative, functional, and oncologic outcomes were analyzed and compared between patients with increasing complexity.

Results: Of the 155 patients, 65 (41.9%) patients had a PADUA score of 10, 55 (35.5%) had a PADUA score of 11, and 35 (22.6%) had a PADUA score of 12-13, respectively. The median (interquartile range) operative time, warm ischemia time and estimated blood loss were 150 min (112-186 min), 26 min (23-32 min) and 250 mL (100-500 mL), respectively. Postoperatively, complications occurred in 25 (16.1%) patients, and positive surgical margins in 15 (10.5%) patients. Trifecta was achieved in 67 (43.2%) patients. At a median follow-up period of 58 months, the median estimated glomerular filtration rate preservation was 87% (78-110), and 12 (7.7%) patients developed new-onset chronic kidney disease. Recurrence-free survival and overall survival rates were 93.6% and 96.7%, respectively. Positive surgical margins were statistically different between the groups of PADUA score 10, 11 and 12-13 (P = 0.017), whereas functional and oncologic outcomes were similar. In multivariate logistic regression analysis, increasing tumor size (odds ratio 1.48, 95% confidence interval 1.21-1.87; P < 0.001) and the American Society of Anesthesiologists score 2/3 (odds ratio 0.48, 95% confidence interval 0.24-0.96; P = 0.041) were independent predictors of trifecta failure.

Conclusions: Robot-assisted partial nephrectomy is a safe and effective treatment for high-complexity tumors providing excellent long-term functional and oncologic outcomes.
Full Text
https://onlinelibrary.wiley.com/doi/10.1111/iju.14507
DOI
10.1111/iju.14507
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Rha, Koon Ho(나군호) ORCID logo https://orcid.org/0000-0001-8588-7584
Lee, Jong Soo(이종수) ORCID logo https://orcid.org/0000-0002-9984-1138
Han, Woong Kyu(한웅규) ORCID logo https://orcid.org/0000-0002-2527-4046
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/186788
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