Experience of robot-assisted laparoscopic partial nephrectomy for renal tumorswith R.E.N.A.L. score ≥10
Wang Jie1 , Liang Xiaolong1 , Wu Zhenjie1 , Liu Jiayi1 , Shi Jiazi1 ,Wang Weiping1 , Bao Yi1 , Ye Huamao2 , Lyu Chen2 , Xu Chuanliang2 ,Sun Yinghao2 , He Yi3 , Liu Bing1 , Wang Linhui1
1.Department of Urology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China;
2.Department of Urology, Changhai Hospital, Second Military Medical University; 3Department of Urology, the First Hospital of Jiaxing
Abstract：Objective: To evaluate the safety, feasibility and efficacy of robot-assisted laparoscopic partial nephrectomy (RAPN) in treating renal tumors with R.E.N.A.L. score ≥10. Methods: All patients receiving RAPN by the same surgeon during May 2012 and Feb 2016 were reviewed. Among them, 38 patients with high complex renal tumors (R.E.N.A.L. score ≥10) were enrolled in this study. The male/female ratio was 26/12 with a mean age of 51.0±11.9 (19-72) years. The mean body mass index was 25.2±3.4 (19.6-35.2) kg/m2, and the mean ASA score was 1.91±1.03 (1 to 2). All tumors were solitary including 16 on the left and 22 on the right. The mean diameter was 4.27±2.27 (2-16) cm. There were 31 cases and 7 cases with R.E.N.A.L. score 10 points and 11 points respectively. The mean preoperative estimated glomerular filtration rate was 97.9±24.3 (69.8-131.4) mL·min-1·1.73 m-2. Results: All procedures were completed successfully except one conversion to open surgery for intraoperative bleeding. The mean operation time was 208.8±46.5 (105-308) min, ischemia time was 26.6±7.4 (14-49) min, and estimated blood loss was 150.3±115.5 (10-600) mL. The mean postoperative hospital stay was 14.4±3.6 (9-25) days. The overall rate of blood transfusion was 5.3% (2/38) and the complication rate was 7.9% (3/38). No positive surgical margin was observed. Postoperative pathology results revealed 32 renal clear cell carcinomas, 1 chromophobe renal cell carcinoma, 1 TFE-3 fusion gene related renal cell carcinoma renal cell carcinoma and 4 angiomyolipomas. The meane eGFR decreased by 7.1% three months after operation with a significant difference compared to preoperativee eGFR (P<0.004). All patients had no local recurrence or distant metastasis during a mean follow-up period of 27.8±9.7 (9-51) months. Conclusions: Robot-assisted laparoscopic partial nephrectomy is safe and effective for high-complexity renal tumors with R.E.N.A.L. ≥10.
