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ORIGINAL ARTICLE
Year : 2022  |  Volume : 38  |  Issue : 4  |  Page : 288-295

Perioperative outcomes following robot-assisted partial nephrectomy for complex renal masses: A Vattikuti Collective Quality Initiative database study


1 Department of Urologic Oncology, Max Institute of Cancer Care, New Delhi, India
2 King's Health Partners, Faculty of Life Sciences and Medicine, King's College, London, UK
3 Department of Urology, Guy's and St. Thomas' Hospital, London, UK
4 Vattikuti Foundation, Henry Ford Hospital, Detroit, MI, USA
5 Department of Urology, Medanta – The Medicity Hospital, New Delhi, India
6 Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
7 Department of Biomedical Sciences, Humanitas University; Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
8 Department of Urooncology, Chennai Urology and Robotics Institute, Chennai, Tamil Nadu, India
9 Swedish Medical Center, Seattle, Washington, USA
10 Department of Urology, Henry Ford Hospital, Detroit, MI, USA
11 ORSI Academy, Melle, Belgium, Europe
12 Central Ohio Urology Group, Mount Carmel St. Ann's Hospital, OH, USA
13 Department of Urology, Yonsei University Health System, Seoul, South Korea
14 Department of Urology, Royal Melbourne Clinical School, Peter MacCallum Hospital, University of Melbourne, Melbourne, Australia
15 Department of Urooncology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
16 Department of Urology, University of Miami Health System, Miami, FL, USA
17 Department of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, MI, Italy
18 Center for Robotics and Minimally Invasive Surgery, Hospital Da Luz, Luz Sáude, Portugal
19 Department of Urology, San Luigi Gonzaga Hospital of Orbassano, Turin, Italy
20 Department of Urology, Altuzinade Hospital, Acibadem M.A. Aydinlar University, Istanbul, Turkey

Correspondence Address:
Gagan Gautam
Department of Urologic Oncology, Max Institute of Cancer Care, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/iju.iju_154_22

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Introduction: Outcomes of robot-assisted partial nephrectomy (RAPN) depend on tumor complexity, surgeon experience and patient profile among other variables. We aimed to study the perioperative outcomes of RAPN for patients with complex renal masses using the Vattikuti Collective Quality Initiative (VCQI) database that allowed evaluation of multinational data. Methods: From the VCQI, we extracted data for all the patients who underwent RAPN with preoperative aspects and dimensions used for an anatomical (PADUA) score of ≥10. Multivariate logistic regression was conducted to ascertain predictors of trifecta (absence of complications, negative surgical margins, and warm ischemia times [WIT] <25 min or zero ischemia) outcomes. Results: Of 3,801 patients, 514 with PADUA scores ≥10 were included. The median operative time, WIT, and blood loss were 173 (range 45–546) min, 21 (range 0–55) min, and 150 (range 50–3500) ml, respectively. Intraoperative complications and blood transfusions were reported in 2.1% and 6%, respectively. In 8.8% of the patients, postoperative complications were noted, and surgical margins were positive in 10.3% of the patients. Trifecta could be achieved in 60.7% of patients. Clinical tumor size, duration of surgery, WIT, and complication rates were significantly higher in the group with a high (12 or 13) PADUA score while the trifecta was significantly lower in this group (48.4%). On multivariate analysis, surgical approach (retroperitoneal vs. transperitoneal) and high PADUA score (12/13) were identified as predictors of the trifecta outcomes. Conclusion: RAPN may be a reasonable surgical option for patients with complex renal masses with acceptable perioperative outcomes.


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