UP-54 Surgical outcomes in robotic-assisted partial nephrectomy for imperative versus elective indications – a propensity score-matched analysis.
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Presenter

JO-LYNN S TAN, Australia

Urology Registrar

Department of Urology

St Vincent's Hospital Melbourne

Abstract

Surgical outcomes in robotic-assisted partial nephrectomy for imperative versus elective indications – A propensity score-matched analysis

Jo-Lynn Tan1, Niranjan Sathianathen Dr1, Marcus Cumberbatch Dr1, James Porter Mr2, Craig Rogers Mr3, Prokar Dasgupta Mr4, Alexandre Mottrie Mr5, Ronney Abaza Mr6, Khoon H Rha Mr7, Thyavihaly B Yuvaraja Mr8, Dipen J Parekh Mr9, Umberto Capitanio Mr10, Rajesh Ahlawat11, Sudhir Rawal, Nicolo M Buffi, A Sivaraman, Kris K Maes, Gagan Gautham, Porpiglia Francesco, Levent Turkeri, Mahendra Bhandari, Daniel Moon Mr.

1Division of Cancer Surgery, Genitourinary Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; 2Department of Urology, Swedish Medical Center, Seattle, WA, United States; 3Department of Urology, Henry Ford Hospital, Detroit, MI, United States; 4DMRC Centre of Transplantation, King's College, London, United Kingdom; 5Urology, ORSI Academy, Melle, Belgium; 6Urology, Dublin Methodist hospital, Ohio, OH, United States; 7Urology, Yonsei University Health System, Seoul, Korea; 8Urology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India; 9Urology, University of Miami Health System, Miami, FL, United States; 10Urology, San Raffaele Hospital, Milan, Italy; 11Urology, Medanta The Medicity Hospital, New Delhi, India; 12Urology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India; 13Urology, Humanitas Research hospital, Milan, Italy; 14Urology, Apollo Hospitals, Chennai, India; 15Urology, Center for Robotic and Minimally Invasive Surgery, Hospital Da Luz, Luz Sáude, Portugal; 16Urology, Max Institute of Cancer Care, New Delhi, India; 17Urology, San Luigi Gonzaga Hospital of Orbassano, Turin, Italy; 18Urology, Acıbadem Hospitals Group, Istanbul, Turkey; 19Vattikuti foundation, Detroit, MI, United States

Vattikuti Foundation & Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan. .

Introduction: Partial nephrectomy (PN) is the standard treatment for kidney tumours in imperative settings, defined as situations where there is a single kidney, bilateral renal tumours, and renal impairment. Limited data is available on robotic-assisted PN (RAPN) outcomes for imperative indications. Although recent data has demonstrated RAPN to have reduced complications and length of hospital stay compared to open PN, fewer RAPN are offered for imperative indications as they are considered “high stakes” scenarios. We sought to compare the peri-operative and surgical outcomes in RAPN performed for imperative versus elective indications.

Methods: We retrospectively interrogated the multinational Vattikuti database of 3,801 RAPN cases for elective and imperative indications. Baseline data for age, gender, BMI, ASA and PADUA score were examined. Primary outcomes included organ ischaemic time, operative time, estimated blood loss, rate of blood transfusions, Clavien-Dindo complications, conversion to radical nephrectomy (RN) and positive surgical margins. Propensity score-matching was performed to match baseline variables and bivariate analysis used to compare outcomes of interest between groups.

Results: 348 patients (87 imperative vs 261 elective indications) were included in the final analysis. No significant differences were found between groups for ischaemic time (18.9min vs 18.6min, p=0.76), operative time (186min vs 180min, p=0.67), estimated blood loss (226ml vs 211ml, p=0.55), rate of blood transfusions (2.5% vs 3.4%, p=0.99), or Clavien-Dindo complications (p=0.88). There were no conversions to RN in the imperative group and 6.3% (n=8) conversions in the non-imperative group (p=0.37). Positive surgical margins were seen in 1.2% (1/87) of the imperative group and 4.1% of the non-imperative group (1/261), p=0.37.

Conclusions: RAPN is feasible and safe for imperative indications, demonstrating comparable, if not superior, outcomes to RAPN performed for elective indications.


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