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Minervini A , Campi R , Lane BR , De Cobelli O , Sanguedolce F , Hatzichristodoulou G , Antonelli A , Noyes S , Mari A , Rodriguez-Faba O , Keeley FX , Langenhuijsen J , Musi G , Klatte T , Roscigno M , Akdogan B , Furlan M , Karakoyunlu N , Marszalek M , Capitanio U , Volpe A , Brookman-May S , Gschwend JE , Smaldone MC , Uzzo RG , Carini M , Kutikov A
Impact of Resection Technique on Perioperative Outcomes and Surgical Margins after Partial Nephrectomy for Localized Renal Masses: A Prospective Multicenter Study
J Urol. 2020 Mar;203(3) :496-504
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PURPOSE: The impact of resection technique on partial nephrectomy outcomes is controversial. The aim of this study was to evaluate the pattern of resection techniques during partial nephrectomy and the impact on perioperative outcomes, acute kidney injury, positive surgical margins and the achievement of the Trifecta (negative surgical margins, no perioperative Clavien-Dindo grade 2 or greater surgical complications and no postoperative acute kidney injury). MATERIALS AND METHODS: We prospectively collected data on consecutive patients with cT1-2N0M0 renal masses treated with partial nephrectomy at a total of 16 referral centers from September 2014 to March 2015. After partial nephrectomy the resection technique was classified by the surgeon as enucleation, enucleoresection or resection according to the SIB (Surface-Intermediate-Base) margin scores 0 to 2, 3 or 4 and 5, respectively. Multivariable logistic regression analysis was done to evaluate the potential impact of the resection technique on postoperative surgical complications, positive surgical margins, acute kidney injury and Trifecta achievement. RESULTS: Overall 507 patients were included in analysis. The resection technique was classified as enucleation in 266 patients (52%), enucleoresection in 150 (30%) and resection in 91 (18%). The resection technique (enucleoresection vs enucleation and resection) was the only significant predictor of positive surgical margins. Tumor complexity, surgical approach (open and laparoscopic vs robotic) and resection technique (enucleoresection vs enucleation) were significant predictors of Clavien-Dindo grade 2 or greater surgical complications. The surgical approach (open and laparoscopic vs robotic), the resection technique (enucleoresection vs enucleation) and warm ischemia time were significantly associated with postoperative acute kidney injury and Trifecta achievement. CONCLUSIONS: Resection techniques significantly impact surgical complications, early functional outcomes and positive surgical margins after partial nephrectomy of localized renal masses.
1527-3792 Minervini, Andrea Campi, Riccardo Lane, Brian R De Cobelli, Ottavio Sanguedolce, Francesco Hatzichristodoulou, Georgios Antonelli, Alessandro Noyes, Sabrina Mari, Andrea Rodriguez-Faba, Oscar Keeley, Frank X Langenhuijsen, Johan Musi, Gennaro Klatte, Tobias Roscigno, Marco Akdogan, Bulent Furlan, Maria Karakoyunlu, Nihat Marszalek, Martin Capitanio, Umberto Volpe, Alessandro Brookman-May, Sabine Gschwend, Jurgen E Smaldone, Marc C Uzzo, Robert G Carini, Marco Kutikov, Alexander Journal Article Multicenter Study United States J Urol. 2020 Mar;203(3):496-504. doi: 10.1097/JU.0000000000000591. Epub 2019 Oct 14.