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Comparison of functional outcomes of robotic and open partial nephrectomy in patients with pre-existing chronic kidney disease: a multicenter study

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Abstract

Background

We compared renal functional outcomes of robotic (RPN) and open partial nephrectomy (OPN) in patients with chronic kidney disease (CKD), a definite indication for nephron-sparing surgery.

Methods

A multicenter retrospective analysis of OPN and RPN in patients with baseline ≥ CKD Stage III [estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2] was performed. Primary outcome was change in eGFR (ΔeGFR, mL/min/1.73 m2) between preoperative and last follow-up with respect to RENAL nephrometry score group [simple (4–6), intermediate (7–9), complex (10–12)]. Secondary outcomes included eGFR decline > 50%.

Results

728 patients (426 OPN, 302 RPN, mean follow-up 33.3 months) were analyzed. Similar RENAL score distribution (p = 0.148) was noted between groups. RPN had lower median estimated blood loss (p < 0.001), and hospital stay (3 vs. 5 days, p < 0.001). Median ischemia time (OPN 23.7 vs. RPN 21.5 min, p = 0.089), positive margin (p = 0.256), transfusion (p = 0.166), and 30-day complications (p = 0.208) were similar. For OPN vs. RPN, mean ΔeGFR demonstrated no significant difference for simple (0.5 vs. 0.3, p = 0.328), intermediate (2.1 vs. 2.1, p = 0.384), and complex (4.9 vs. 6.1, p = 0.108). Cox regression analysis demonstrated that decreasing preoperative eGFR (OR 1.10, p = 0.001) and complex RENAL score (OR 5.61, p = 0.03) were independent predictors for eGFR decline > 50%. Kaplan–Meier analysis demonstrated 5-year freedom from eGFR decline > 50% of 88.6% for OPN and 88.3% for RPN (p = 0.724).

Conclusions

RPN and OPN demonstrated similar renal functional outcomes when stratified by tumor complexity group. Increasing tumor age and tumor complexity were primary drivers associated with functional decline. RPN provides similar renal functional outcomes to OPN in appropriately selected patients.

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Acknowledgements

The project was supported by Stephen Weissman Kidney Cancer Research Fund. Biostatistical analyses were supported by NIH Grants UL1TR000100/UL1TR001442.

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Authors and Affiliations

  1. Department of Urology, UC San Diego Health System, Moores UCSD Cancer Center, 3855 Health Sciences Drive, La Jolla, CA, 93093-0987, USA

    Zachary A. Hamilton, Stephen Ryan, Madhumitha Reddy, Ryan Nasseri, Kendrick Yim, Ahmet Bindayi & Ithaar H. Derweesh

  2. Department of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA

    Robert G. Uzzo, Benjamin Ristau & Andres Correa

  3. Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Alessandro Larcher, Umberto Capitanio, Sumi Dey, Sabrina Noyes & Francesco Montorsi

  4. Division of Urology, Spectrum Health, Grand Rapids, MI, USA

    Brian R. Lane

  5. Clinical and Translational Research Institute, UC San Diego, La Jolla, CA, USA

    James A. Proudfoot

Authors
  1. Zachary A. Hamilton
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  2. Robert G. Uzzo
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  3. Alessandro Larcher
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  4. Brian R. Lane
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  5. Benjamin Ristau
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  6. Umberto Capitanio
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  7. Stephen Ryan
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  9. Andres Correa
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  10. Madhumitha Reddy
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  12. Ryan Nasseri
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  13. Kendrick Yim
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  15. Ahmet Bindayi
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  17. Ithaar H. Derweesh
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Contributions

Hamilton: project development and manuscript writing/editing. Uzzo: protocol development and manuscript editing. Larcher: data collection, data analysis and manuscript writing/editing. Lane: protocol development and manuscript writing/editing. Capitanio: data interpretation and manuscript writing/editing. Ristau: data collection, data analysis and manuscript writing/editing. Ryan: data collection and data management. Dey: data collection and data management and interpretation. Correa: data collection and data management. Reddy: data collection and data management. Proudfoot: data collection, data management and data analysis. Nasseri: data collection, data management and data analysis. Yim: data collection and data management. Noyes: data collection and data analysis. Correa: data collection and manuscript editing. Bindayi: data analysis and manuscript writing. Montorsi: project development and manuscript editing. Derweesh: protocol/project development and manuscript writing/editing.

Corresponding author

Correspondence to Ithaar H. Derweesh.

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None of the authors have any conflict of interest to declare.

Ethical standards

Ethical standards have been met; the study has been IRB approved at all institutions.

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Hamilton, Z.A., Uzzo, R.G., Larcher, A. et al. Comparison of functional outcomes of robotic and open partial nephrectomy in patients with pre-existing chronic kidney disease: a multicenter study. World J Urol 36, 1255–1262 (2018). https://doi.org/10.1007/s00345-018-2261-3

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  • DOI: https://doi.org/10.1007/s00345-018-2261-3

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