Predictors of perioperative outcomes during robot-assisted partial nephrectomy

Abstract

Abstract Purpose: Robot-assisted partial nephrectomy (RPN) has emerged as an alternative treatment for the management of small renal masses. This study was designed to investigate parameters that predict perioperative outcomes during RPN.

Materials and methods: We retrospectively reviewed the medical records of 113 patients who underwent RPN between September 2008 and May 2012, at the Seoul National University Bundang Hospital. Clinical parameters, including warm ischemia time (WIT), estimated blood loss (EBL), R.E.N.A.L and PADUA score, were evaluated to predict perioperative outcomes.

Results: Of the 113 patients, 81 were men and 32 women. Mean age was 53.5 years, and mean body mass index was 22.3 kg/m². Age, gender, and mass laterality had no effect on perioperative complications, WIT, or EBL. Univariate analysis revealed that the distance between the tumor and the collecting system ≤4 mm or renal mass size >4cm were associated with adverse profiles of WIT and EBL. However, multivariate analysis showed no association between the predictive parameters and tumor complexity as assessed by nephrometry scores. Tumor size of >4 cm increased the risk of blood loss >300 mL(OR: 3.5, 95% CI 1.3-9.7, P = 0.016). A distance between the tumor and the collecting system of ≤4 mm was associated with increased risk of WIT exceeding 20 min (OR: 2.8, 95% CI 1.3-6.3, P = 0.012).

Conclusions: Tumor size and proximity of the mass to the collecting system showed significant association with EBL and WIT, respectively, during RPN. R.E.N.A.L and PADUA nephrometry scoring system itself did not predict perioperative outcomes.

Keywords: Carcinoma, Renal cell

Nephrectomy

Robotics

Warm Ischemia

Blood Loss, Surgical